Provider Demographics
NPI:1164194361
Name:MCKOY, CATHERINE GLENDA AALIYAH
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:GLENDA AALIYAH
Last Name:MCKOY
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 1:5933 DEBARR RD APT 110A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2379
Mailing Address - Country:US
Mailing Address - Phone:907-317-1533
Mailing Address - Fax:
Practice Address - Street 1:5933 DEBARR RD APT 110A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2379
Practice Address - Country:US
Practice Address - Phone:907-317-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK174264225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist