Provider Demographics
NPI:1831341601
Name:MCKENNA, PATRICK (OTR)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 CHARDONNAY DR
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-3829
Mailing Address - Country:US
Mailing Address - Phone:631-278-0665
Mailing Address - Fax:203-651-1877
Practice Address - Street 1:143 CHARDONNAY DR
Practice Address - Street 2:
Practice Address - City:EAST QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11942-3829
Practice Address - Country:US
Practice Address - Phone:631-278-0665
Practice Address - Fax:203-651-1877
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002435314000000X
CT2435225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility