Provider Demographics
NPI:1215709647
Name:SEIDEL, MACKENZIE ANN (MOT)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ANN
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:ANN
Other - Last Name:DEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6910 HIGHWAY 5 N
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7901
Mailing Address - Country:US
Mailing Address - Phone:501-585-7580
Mailing Address - Fax:
Practice Address - Street 1:6910 HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7901
Practice Address - Country:US
Practice Address - Phone:501-585-7580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics