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General NPI Number Information
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NPI Number | 1134939796
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Entity Type | Individual
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Provider Name | MAKENNA MAUCHER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1000 CALLE AMANECER
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6214
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Country | US
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Telephone | 949-498-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 218 AGATE AVE
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City | NEWPORT BEACH
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State | CA
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Zip | 92662-1029
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Country | US
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Telephone | 626-483-1395
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 27299
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License Number State | CA
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