Healthcare Provider Details

I. General information

NPI: 1073055711
Provider Name (Legal Business Name): VICTORIA MCCOY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10075 S JOG RD STE 201
BOYNTON BEACH FL
33437-3536
US

IV. Provider business mailing address

10075 S JOG RD STE 201
BOYNTON BEACH FL
33437-3536
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-1012
  • Fax:
Mailing address:
  • Phone: 561-733-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 18019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: