Individual
MS. ANDREA MARIE MACKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1800 CAMELOT DR, SUITE 300, VIRGINIA BEACH, VA 23454-2440
(757) 321-4284
(757) 321-4287
Mailing address
230 CLEARFIELD AVE, SUITE 124, VIRGINIA BEACH, VA 23462-1832
(757) 321-3383
(757) 321-3332
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
102984
MN
225XH1200X
Hand Occupational Therapist
Primary
0119004275
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05501
MEDICARE GROUP
VA
Enumeration date
08/24/2006
Last updated
09/02/2009
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