Individual
MR. ETHAN POLEY MCKENNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9 OSPREY DR, PORTSMOUTH, NH 03801-3335
(484) 794-4037
Mailing address
9 OSPREY DR, PORTSMOUTH, NH 03801-3335
(484) 794-4037
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0893
NH
Other
Enumeration date
10/12/2022
Last updated
10/12/2022
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