Provider Demographics
NPI:1497960611
Name:MCCOY, LARRY EDWARD (OTR)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:EDWARD
Last Name:MCCOY
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WINDWARD LN
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3318
Mailing Address - Country:US
Mailing Address - Phone:606-754-4134
Mailing Address - Fax:606-754-5704
Practice Address - Street 1:945 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:ELKHORN CITY
Practice Address - State:KY
Practice Address - Zip Code:41522-7071
Practice Address - Country:US
Practice Address - Phone:606-754-4134
Practice Address - Fax:606-754-5704
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2027225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist