Individual
MR. TRAVIS EUGENE MACKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1375 S COLUMBIA RD - ALTRU PERFORMANCE CENTER, GRAND FORKS, ND 58201
(701) 780-5000
Mailing address
2401 DEMERS AVE, GRAND FORKS, ND 58201
(701) 780-1891
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
940
ND
Other
Enumeration date
06/11/2007
Last updated
07/02/2019
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