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NPI Code Detail

MEDICARE: KELLY GRACE MCKENZIE OTR/L

MEDICARE: KELLY GRACE MCKENZIE 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 Therapist4832NC

General Provider Information

NPI Number : 1336384205
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY GRACE MCKENZIE OTR/L
Provider Business Mailing Address
First Line : 2509 BRIGHTHAVEN DR
Second Line :
City : RALEIGH
State : NC
Zip : 27614-8806
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 SAWMILL RD
Second Line :
City : RALEIGH
State : NC
Zip : 27615-4320
Country : US
Telephone Number : 919-870-9322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2008
Last Update Date : 12/08/2008

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