Provider Demographics
NPI:1962212761
Name:RYDER, MAKENZIE
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:RYDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 INFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8026
Mailing Address - Country:US
Mailing Address - Phone:704-799-6824
Mailing Address - Fax:704-799-6825
Practice Address - Street 1:1777 OLD EARNHARDT RD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-8023
Practice Address - Country:US
Practice Address - Phone:704-799-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17312225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist