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NPI Code Detail

MEDICARE: KELLI CLAIRE MACKIE OTR/L

MEDICARE: KELLI CLAIRE MACKIE OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist7337NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
168681OTHERNCBCBSNC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255667176
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI CLAIRE MACKIE OTR/L
Provider Business Mailing Address
First Line : PO BOX 587
Second Line :
City : LEXINGTON
State : NC
Zip : 27293-0587
Country : US
Telephone Number : 336-236-6546
Fax Number : 336-236-9546
Provider Business Practice Location Address
First Line : 440 CENTRAL AVE
Second Line :
City : LEXINGTON
State : NC
Zip : 27292-2634
Country : US
Telephone Number : 336-236-6546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2009
Last Update Date : 10/28/2009

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