Healthcare Provider Details

I. General information

NPI: 1669300661
Provider Name (Legal Business Name): KOTYLECHAE C MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KOTY MCCOY

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 ESSINGTON RD
JOLIET IL
60435-4912
US

IV. Provider business mailing address

10101 S PAXTON AVE
CHICAGO IL
60617-5634
US

V. Phone/Fax

Practice location:
  • Phone: 779-223-5316
  • Fax:
Mailing address:
  • Phone: 773-931-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: