=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114241163
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARLENE E. MCKENNEY LMT/ PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2010
-----------------------------------------------------
Last Update Date | 09/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 822 WEBSTER ST
-----------------------------------------------------
City | MARSHFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02050-3452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-733-4084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 822 WEBSTER ST
-----------------------------------------------------
City | MARSHFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02050-3452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-733-4084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 1973
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA-40583
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------