Provider Demographics
NPI:1629098793
Name:MCCOY, DIANE M (ATC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:MCCOY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 NORTHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1443
Mailing Address - Country:US
Mailing Address - Phone:443-939-2904
Mailing Address - Fax:202-537-5783
Practice Address - Street 1:NATIONAL CATHEDRAL SCHOOL
Practice Address - Street 2:3612 WOODLEY ROAD, N.W.
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016
Practice Address - Country:US
Practice Address - Phone:202-537-5789
Practice Address - Fax:202-537-5783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer