Provider Demographics
NPI:1457682015
Name:MCCORMICK, NANCY L (OTR/L)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 US HIGHWAY 1
Mailing Address - Street 2:SUITE 2 , BOX 119
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5783
Mailing Address - Country:US
Mailing Address - Phone:954-914-4063
Mailing Address - Fax:772-492-9953
Practice Address - Street 1:1275 US HIGHWAY 1
Practice Address - Street 2:SUITE 2, BOX 119
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5783
Practice Address - Country:US
Practice Address - Phone:954-914-4063
Practice Address - Fax:772-492-9953
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT0591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003540800Medicaid