Individual
MACKINZIE LEE VERDEGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2217 DUNCAN ROAD, BLOOMER, WI 54724
(715) 641-0510
Mailing address
2217 DUNCAN ROAD, BLOOMER, WI 54724
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5795-27
WI
Other
Enumeration date
08/10/2021
Last updated
08/22/2025
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