Provider Demographics
NPI:1457514150
Name:MCKENNA, JEANE LOUISE (OTR L)
Entity Type:Individual
Prefix:MS
First Name:JEANE
Middle Name:LOUISE
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 1:27 HARVEY LANE
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382
Mailing Address - Country:US
Mailing Address - Phone:781-447-5657
Mailing Address - Fax:
Practice Address - Street 1:11 MCGRATH HIGHWAY
Practice Address - Street 2:QUINCY REHABILITATION AND NURSING CENTER
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-479-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7606225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist