Provider Demographics
NPI:1497320873
Name:HARVEY, MYCHAYLA TATYANA (COTA/L)
Entity Type:Individual
Prefix:
First Name:MYCHAYLA
Middle Name:TATYANA
Last Name:HARVEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 E TRINITY MILLS RD APT 1317
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-7824
Mailing Address - Country:US
Mailing Address - Phone:601-951-1792
Mailing Address - Fax:
Practice Address - Street 1:8523 THACKERY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-3903
Practice Address - Country:US
Practice Address - Phone:214-265-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216548224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant