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General NPI Number Information
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NPI Number | 1740845510
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Entity Type | Organization
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Legal Business Name | SUSAN MCKENNA OCCUPATIONAL THERAPY PC
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 3500 EUGENES RD
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City | CUTCHOGUE
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State | NY
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Zip | 11935-2104
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Country | US
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Telephone | 631-834-1604
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Fax | 631-734-8474
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Provider Business Mailing Address
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Address Line | 3500 EUGENES RD
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City | CUTCHOGUE
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State | NY
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Zip | 11935-2104
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Country | US
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Telephone | 631-834-1604
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Fax | 631-734-8474
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST / OWNER
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Name | SUSAN D. MCKENNA
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Credential | OTR/L
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Telephone | 631-834-1604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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