Provider Demographics
NPI:1205139052
Name:MCCOY, DEANDRA L (COTAL)
Entity type:Individual
Prefix:MRS
First Name:DEANDRA
Middle Name:L
Last Name:MCCOY
Suffix:
Gender:F
Credentials:COTAL
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 367
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-0367
Mailing Address - Country:US
Mailing Address - Phone:405-585-7234
Mailing Address - Fax:
Practice Address - Street 1:622 MCNABB
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:OK
Practice Address - Zip Code:74047-0698
Practice Address - Country:US
Practice Address - Phone:918-261-7740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOA827224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant