Provider Demographics
NPI:1376143925
Name:THOMAS, MCKENNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MCKENNA
Other - Middle Name:
Other - Last Name:COLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:295 VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1503
Mailing Address - Country:US
Mailing Address - Phone:508-641-4703
Mailing Address - Fax:
Practice Address - Street 1:65 WALNUT ST STE 580
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2194
Practice Address - Country:US
Practice Address - Phone:781-489-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12370225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics