Provider Demographics
NPI:1821095043
Name:MCCOY, ELIZABETH J (OT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:MCCOY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-0136
Mailing Address - Country:US
Mailing Address - Phone:540-962-6226
Mailing Address - Fax:540-962-7447
Practice Address - Street 1:320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1517
Practice Address - Country:US
Practice Address - Phone:540-962-6226
Practice Address - Fax:540-962-7447
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002847225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6700001706OtherRAILROAD MEDICARE PROV NU
VA195326OtherANTHEM PROVIDER NUMBER
VA6700001706OtherRAILROAD MEDICARE PROV NU