Provider Demographics
NPI:1174243422
Name:FORD, MCKENNA MARY
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:MARY
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-1003
Mailing Address - Country:US
Mailing Address - Phone:585-201-1885
Mailing Address - Fax:
Practice Address - Street 1:102 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4104
Practice Address - Country:US
Practice Address - Phone:701-252-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist