Individual
MACKENZIE BALDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
110 CARVER LN, EAST PEORIA, IL 61611-3052
(309) 282-6704
Mailing address
110 CARVER LN, EAST PEORIA, IL 61611-3052
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
225X00000X
Occupational Therapist
Primary
056012879
IL
225XP0200X
Pediatric Occupational Therapist
56.012879
IL
Other
Enumeration date
07/10/2017
Last updated
04/02/2025
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