Healthcare Provider Details

I. General information

NPI: 1053331744
Provider Name (Legal Business Name): CATHY LYNN MCCOY L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 RABBIT CT
SPRING GROVE IL
60081-8711
US

IV. Provider business mailing address

2726 RABBIT COURT
SPRING GROVE IL
60081
US

V. Phone/Fax

Practice location:
  • Phone: 847-690-6179
  • Fax: 847-549-6920
Mailing address:
  • Phone: 847-690-6179
  • Fax: 847-549-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: