Individual
JESSICA J MCKENNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1435
WV
225X00000X
Occupational Therapist
OC01116
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810015720
—
WV
Enumeration date
07/14/2009
Last updated
04/15/2019
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