Individual
TARA MACKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
306 SNUG HARBOR RD, NEWPORT BEACH, CA 92663-5843
(214) 288-4503
Mailing address
306 SNUG HARBOR RD, NEWPORT BEACH, CA 92663-5843
(214) 288-4503
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
13460
CA
Other
Enumeration date
02/15/2016
Last updated
02/15/2016
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