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NPI Code Detail

MEDICARE: MACKENZIE HAGMANN MSOTR

MEDICARE: MACKENZIE HAGMANN MSOTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist026668-01NY

General Provider Information

NPI Number : 1447993894
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE HAGMANN MSOTR
Provider Business Mailing Address
First Line : 112 ELMCREST CIR
Second Line :
City : LIVERPOOL
State : NY
Zip : 13090-2823
Country : US
Telephone Number : 315-558-0254
Fax Number :
Provider Business Practice Location Address
First Line : 750 E ADAMS ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-2306
Country : US
Telephone Number : 315-464-6543
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2022
Last Update Date : 12/31/2025

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Directions to “ MACKENZIE HAGMANN MSOTR” Practice Location

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