Provider Demographics
NPI:1972831634
Name:MCCOY, MICHELLE L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:182 KNOLL RD.
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-952-9324
Mailing Address - Fax:
Practice Address - Street 1:1020 SOUTH 40TH AVE
Practice Address - Street 2:SUITE E
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-952-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60106038225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist