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General NPI Number Information
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NPI Number | 1255807319
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Entity Type | Individual
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Provider Name | MACKENZIE LEIGH MARQUES ATC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 05/25/2020
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Provider Practice Location Address
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Address Line | 12 SEAHAWKS WAY
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City | RENTON
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State | WA
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Zip | 98056-1572
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Country | US
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Telephone | 425-443-4120
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Fax |
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Provider Business Mailing Address
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Address Line | 12 SEAHAWKS WAY
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City | RENTON
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State | WA
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Zip | 98056-1572
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Country | US
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Telephone | 425-443-4120
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 003792
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 61070321
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License Number State | WA
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