Provider Demographics
NPI:1558101428
Name:FITZGERALD, MACKENZIE RAE (OTR/L)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 SHARON CIR
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2917
Mailing Address - Country:US
Mailing Address - Phone:610-844-7384
Mailing Address - Fax:
Practice Address - Street 1:230 STONEBRIDGE SQ
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-9505
Practice Address - Country:US
Practice Address - Phone:252-571-2078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16132225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics