Individual
MACKENZIE LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9129 MONROE RD STE 100-105, CHARLOTTE, NC 28270-2429
(704) 847-3911
Mailing address
9129 MONROE RD STE 100-105, CHARLOTTE, NC 28270-2429
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851335459
—
NC
Enumeration date
08/07/2015
Last updated
08/07/2015
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