Healthcare Provider Details

I. General information

NPI: 1407737034
Provider Name (Legal Business Name): MACKENZIE LILLIS OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LOCUST ST STE 321-333
DOVER NH
03820-3753
US

IV. Provider business mailing address

58 OLD CONCORD TPKE APT 4
BARRINGTON NH
03825-3153
US

V. Phone/Fax

Practice location:
  • Phone: 603-740-3534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL36347
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4121
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: