Provider Demographics
NPI:1932721909
Name:FRID, MAKENZIE LAURA (OTR/L)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:LAURA
Last Name:FRID
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:LAURA
Other - Last Name:HOLMSBORG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2210 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2149
Mailing Address - Country:US
Mailing Address - Phone:908-894-8008
Mailing Address - Fax:
Practice Address - Street 1:2210 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2149
Practice Address - Country:US
Practice Address - Phone:908-894-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61081972225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty