Healthcare Provider Details

I. General information

NPI: 1447985122
Provider Name (Legal Business Name): MAKENZIE HURLEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 NORTHERN VALLEY PL NE
ROCHESTER MN
55906-3954
US

IV. Provider business mailing address

10127 COUNTY ROAD 10 SE
CHATFIELD MN
55923-3530
US

V. Phone/Fax

Practice location:
  • Phone: 507-259-1026
  • Fax:
Mailing address:
  • Phone: 507-259-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number106883
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: