Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | 8949 | MA |
NPI | 1043427412 |
---|---|
Provider Name | Mr. Matthew Patrick Mckenna |
First Address | Belmont, MA 02478 |
Second Address | Belmont, MA 02478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |