Provider Demographics
NPI:1104294420
Name:HAY, MAKENZIE LAUREN (LMT)
Entity type:Individual
Prefix:MRS
First Name:MAKENZIE
Middle Name:LAUREN
Last Name:HAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:REY
Other - Last Name:SHELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2556 COREY RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-9406
Mailing Address - Country:US
Mailing Address - Phone:541-841-1199
Mailing Address - Fax:541-879-3025
Practice Address - Street 1:2556 COREY RD
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-9406
Practice Address - Country:US
Practice Address - Phone:541-841-1199
Practice Address - Fax:541-879-3025
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21580225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist