Provider Demographics
NPI:1891452793
Name:MCCOY, CATHERINE ELIZABETH (OTR/L OTD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:MCCOY
Suffix:
Gender:F
Credentials:OTR/L OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-1604
Mailing Address - Country:US
Mailing Address - Phone:161-533-9760
Mailing Address - Fax:
Practice Address - Street 1:7927 SE ORIENT DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-8847
Practice Address - Country:US
Practice Address - Phone:503-663-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR431505225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist