Healthcare Provider Details

I. General information

NPI: 1699190595
Provider Name (Legal Business Name): MINDY KARYL MCCOY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7256 CR 2145
BARTLESVILLE OK
74003
US

IV. Provider business mailing address

2208 W DETROIT ST STE 208
BROKEN ARROW OK
74012-3630
US

V. Phone/Fax

Practice location:
  • Phone: 918-899-3134
  • Fax:
Mailing address:
  • Phone: 918-806-0106
  • Fax: 918-806-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1851
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: