Healthcare Provider Details

I. General information

NPI: 1508148578
Provider Name (Legal Business Name): VANESSA REA MACKAY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST ST NE
WASHINGTON DC
20002-3361
US

IV. Provider business mailing address

PO BOX 894
FOLLY BEACH SC
29439-0894
US

V. Phone/Fax

Practice location:
  • Phone: 843-801-5063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number06382
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10473
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010000758
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: