Provider Demographics
NPI:1043490394
Name:MCCOY, TERI R (LMT)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:R
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 NE KINGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9056
Mailing Address - Country:US
Mailing Address - Phone:503-474-2072
Mailing Address - Fax:
Practice Address - Street 1:240 NE KINGWOOD CT
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9056
Practice Address - Country:US
Practice Address - Phone:503-474-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist