Provider Demographics
NPI:1740595693
Name:MCCOY, MAILE LYNN (CMT, LMT, NCBTMB)
Entity Type:Individual
Prefix:
First Name:MAILE
Middle Name:LYNN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:CMT, LMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 FIRST ST
Mailing Address - Street 2:STE 209
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4485
Mailing Address - Country:US
Mailing Address - Phone:925-577-5664
Mailing Address - Fax:925-292-4449
Practice Address - Street 1:1985 FIRST ST
Practice Address - Street 2:STE 209
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4485
Practice Address - Country:US
Practice Address - Phone:925-577-5664
Practice Address - Fax:925-292-4449
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist