Individual
MARIBETH MACKINNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2387 STATE ROUTE 22, PERU, NY 12972-4973
(518) 569-1523
Mailing address
2387 STATE ROUTE 22, PERU, NY 12972-4973
(518) 569-1523
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
005771-1
NY
Other
Enumeration date
12/28/2008
Last updated
12/28/2008
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