Provider Demographics
NPI:1891411336
Name:ROY, MCKENZIE PAULINE
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:PAULINE
Last Name:ROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-3191
Mailing Address - Country:US
Mailing Address - Phone:508-752-8466
Mailing Address - Fax:
Practice Address - Street 1:29 AUTUMN LN
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1254
Practice Address - Country:US
Practice Address - Phone:774-249-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist