Provider Demographics
NPI:1891983722
Name:MCCORMICK, JEAN LOIS (EDS, MT-BC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:LOIS
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:EDS, MT-BC
Other - Prefix:
Other - First Name:SPECIAL
Other - Middle Name:ACCESS
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3401 SPANISH TRAIL
Mailing Address - Street 2:#349G
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-4780
Mailing Address - Country:US
Mailing Address - Phone:561-278-5150
Mailing Address - Fax:
Practice Address - Street 1:3401 SPANISH TRAIL
Practice Address - Street 2:#349G
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-4780
Practice Address - Country:US
Practice Address - Phone:561-278-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No174400000XOther Service ProvidersSpecialist