Individual
MACKENZIE DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AT, ATC
Contact information
Practice address
6191 KRAFT AVE SE, GRAND RAPIDS, MI 49512-9396
(616) 871-6738
Mailing address
6130 WOODFIELD DR SE APT 2, GRAND RAPIDS, MI 49548-8516
(574) 274-6598
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601002811
MI
2255A2300X
Athletic Trainer
36003148A
IN
2255A2300X
Athletic Trainer
AT.0002319
CO
Other
Enumeration date
01/24/2017
Last updated
11/16/2023
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