Provider Demographics
NPI:1528224540
Name:MCEVOY, DAVID (OTR)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MCEVOY
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 1:3 PURPLE HEART WAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1634
Mailing Address - Country:US
Mailing Address - Phone:845-769-5074
Mailing Address - Fax:
Practice Address - Street 1:3 PURPLE HEART WAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-1634
Practice Address - Country:US
Practice Address - Phone:845-769-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist