Individual
MACKENZIE GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4759 RESERVOIR RD NW, WASHINGTON, DC 20007-1921
(202) 965-6600
Mailing address
4759 RESERVOIR RD NW, WASHINGTON, DC 20007-1921
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT010001719
DC
Other
Enumeration date
09/03/2020
Last updated
09/03/2020
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