Individual
STACEY MACKINTOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12 MAGNOLIA ST, EASTON, MD 21601-3657
(410) 763-6823
Mailing address
2103 LAURANCE CT, CROFTON, MD 21114-2129
(410) 320-7948
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
08780
MD
Other
Enumeration date
08/23/2019
Last updated
08/23/2019
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