Individual
MACKENZIE LUCIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2012 IRONWOOD CIR STE 230, SOUTH BEND, IN 46635-1889
(574) 387-4049
Mailing address
2012 IRONWOOD CIR STE 230, SOUTH BEND, IN 46635-1889
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002218A
IN
Other
Enumeration date
07/07/2012
Last updated
07/07/2012
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