Provider Demographics
NPI:1912753690
Name:MCCOY GAURRICH, DENISE MARIE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:MCCOY GAURRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 JONES ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-1413
Mailing Address - Country:US
Mailing Address - Phone:330-714-5808
Mailing Address - Fax:
Practice Address - Street 1:1057 JONES ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-1413
Practice Address - Country:US
Practice Address - Phone:330-714-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRL244470172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver