Provider Demographics
NPI:1871824433
Name:MCCOY, MICHELLE (LMP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
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:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:TRACYTON
Mailing Address - State:WA
Mailing Address - Zip Code:98393-0071
Mailing Address - Country:US
Mailing Address - Phone:360-286-0099
Mailing Address - Fax:
Practice Address - Street 1:542 NE CONIFER DR
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-9224
Practice Address - Country:US
Practice Address - Phone:360-286-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WAMA12015225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula