Basic Information
| Provider Information | |||||||||
| NPI: | 1598499931 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WIECIECH | ||||||||
| FirstName: | MAKENZIE | ||||||||
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| Credential: | MOT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 CORPORATE DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352425424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234056356 | ||||||||
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| Practice Location | |||||||||
| Address1: | 620 W MACPHAIL RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103999590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2022 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 09690 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.