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General NPI Number Information
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NPI Number | 1861654162
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Entity Type | Individual
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Provider Name | MACKENZIE MAE ERICKSON OTR/L, CLT
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Gender | Female
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 1200 1ST AVE E
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City | SPENCER
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State | IA
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Zip | 51301-4342
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Country | US
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Telephone | 712-264-6593
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Fax |
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Provider Business Mailing Address
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Address Line | 72233 460TH AVE
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City | LAKEFIELD
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State | MN
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Zip | 56150-3345
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Country | US
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Telephone | 712-264-5693
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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 | 01703
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License Number State | IA
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