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General NPI Number Information
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NPI Number | 1508334152
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Entity Type | Individual
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Provider Name | MACKENZIE RENE RICE ATC, OPE-C
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Gender | Female
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 2101 DUDLEY AVE
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City | PARKERSBURG
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State | WV
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Zip | 26101-3462
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Country | US
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Telephone | 304-488-3610
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Fax |
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Provider Business Mailing Address
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Address Line | 741 CAMPBELL DR
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City | BELPRE
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State | OH
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Zip | 45714-1217
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Country | US
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Telephone | 304-488-3610
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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 | AT001613
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License Number State | WV
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