Provider Demographics
NPI:1699190595
Name:MCCOY, MINDY KARYL (OTR/L)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:KARYL
Last Name:MCCOY
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 1:2208 W DETROIT ST
Mailing Address - Street 2:STE 208
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3630
Mailing Address - Country:US
Mailing Address - Phone:918-806-0106
Mailing Address - Fax:918-806-0113
Practice Address - Street 1:7256 CR 2145
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003
Practice Address - Country:US
Practice Address - Phone:918-899-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1851225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics