Provider Demographics
NPI:1811232473
Name:MCCOY, LINDA KAY (LMP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9211 227TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-7428
Mailing Address - Country:US
Mailing Address - Phone:253-208-6107
Mailing Address - Fax:360-829-5273
Practice Address - Street 1:18310 STATE ROUTE 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8532
Practice Address - Country:US
Practice Address - Phone:253-208-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist