Provider Demographics
NPI:1851283725
Name:WOODWORTH, MCKENNA MARIE (MSOT, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MCKENNA
Middle Name:MARIE
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 COPPERWOOD RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-2295
Mailing Address - Country:US
Mailing Address - Phone:607-302-8258
Mailing Address - Fax:
Practice Address - Street 1:3851 COMMERCIAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4146
Practice Address - Country:US
Practice Address - Phone:843-314-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist