Provider Demographics
NPI:1083469209
Name:WILSON, MACKENZIE STEGER (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:STEGER
Last Name:WILSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ENERGY CENTER BLVD APT 4311
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-2778
Mailing Address - Country:US
Mailing Address - Phone:205-270-2991
Mailing Address - Fax:
Practice Address - Street 1:2703 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-3226
Practice Address - Country:US
Practice Address - Phone:205-248-7064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6361225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist