Healthcare Provider Details

I. General information

NPI: 1750880365
Provider Name (Legal Business Name): MACKENZIE DRISLANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 KINGS HWY
LEWES DE
19958-1735
US

IV. Provider business mailing address

1270 KINGS HWY
LEWES DE
19958-1735
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-6686
  • Fax:
Mailing address:
  • Phone: 302-645-6686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: