Provider Demographics
NPI:1255512257
Name:MCCOY, EDITH ELIZABETH (ODT, OTR/L, CLT)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:ELIZABETH
Last Name:MCCOY
Suffix:
Gender:F
Credentials:ODT, OTR/L, CLT
Other - Prefix:DR
Other - First Name:EDITH
Other - Middle Name:ELIZABETH
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ODT, OTR/L, CLT
Mailing Address - Street 1:35 OLD KINGS RD N
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8227
Mailing Address - Country:US
Mailing Address - Phone:389-445-5555
Mailing Address - Fax:389-445-9800
Practice Address - Street 1:35 OLD KINGS RD N
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137
Practice Address - Country:US
Practice Address - Phone:389-445-5555
Practice Address - Fax:389-445-9800
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-6943OtherMEDICARE