Individual
MACY KAE TICKNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
1501 E 10TH ST, ATLANTIC, IA 50022-1936
(712) 243-3250
Mailing address
69324 770TH ST, BRIDGEWATER, IA 50837-8507
(712) 590-0127
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
127298
IA
Other
Enumeration date
11/12/2024
Last updated
11/12/2024
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