Healthcare Provider Details

I. General information

NPI: 1043836398
Provider Name (Legal Business Name): MACKENZIE REYES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 E BOGARD RD STE 1
WASILLA AK
99654-7174
US

IV. Provider business mailing address

4935 S SAILORS LOOP
WASILLA AK
99623-0547
US

V. Phone/Fax

Practice location:
  • Phone: 907-521-4566
  • Fax:
Mailing address:
  • Phone: 907-414-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number259111
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: