Individual
MACKENZIE R MOUSOULEAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
21267 MAYFAIR ST, WOODHAVEN, MI 48183-1609
(734) 672-2933
Mailing address
21267 MAYFAIR ST, WOODHAVEN, MI 48183-1609
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M242570730993
STATE ID
MI
Enumeration date
12/01/2019
Last updated
12/01/2019
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