Provider Demographics
NPI:1053331744
Name:MCCOY, CATHY LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:LYNN
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 1:2726 RABBIT COURT
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081
Mailing Address - Country:US
Mailing Address - Phone:847-690-6179
Mailing Address - Fax:847-549-6920
Practice Address - Street 1:2726 RABBIT CT
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-8711
Practice Address - Country:US
Practice Address - Phone:847-690-6179
Practice Address - Fax:847-549-6920
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist