Provider Demographics
NPI:1619346251
Name:MCKENNA, ALESSANDRA MARIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:MARIA
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 FAIRMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-4013
Mailing Address - Country:US
Mailing Address - Phone:617-319-5731
Mailing Address - Fax:
Practice Address - Street 1:11 ALDERSGATE WAY
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-3231
Practice Address - Country:US
Practice Address - Phone:978-664-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11749225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11479OtherOCCUPATIONAL THERAPY LICENSE