Healthcare Provider Details

I. General information

NPI: 1407792690
Provider Name (Legal Business Name): MCKENNA MEWHORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 N EASTOWN RD
ELIDA OH
45807-2020
US

IV. Provider business mailing address

104 S MAIN ST
HARROD OH
45850-8727
US

V. Phone/Fax

Practice location:
  • Phone: 567-371-3114
  • Fax:
Mailing address:
  • Phone: 937-407-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.026781
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: