Healthcare Provider Details

I. General information

NPI: 1699649376
Provider Name (Legal Business Name): RAVEN MACKENZIE SEWELL OTR/L, OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 ABUTMENT RD
DALTON GA
30721-4680
US

IV. Provider business mailing address

3331 OAK BURR DR
CHATTANOOGA TN
37419-1119
US

V. Phone/Fax

Practice location:
  • Phone: 423-994-2442
  • Fax:
Mailing address:
  • Phone: 423-994-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7979
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9674
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: