Healthcare Provider Details

I. General information

NPI: 1891452793
Provider Name (Legal Business Name): CATHERINE ELIZABETH MCCOY OTR/L OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7927 SE ORIENT DR
GRESHAM OR
97080-8847
US

IV. Provider business mailing address

3720 SE 3RD ST
GRESHAM OR
97080-1604
US

V. Phone/Fax

Practice location:
  • Phone: 503-663-0481
  • Fax:
Mailing address:
  • Phone: 161-533-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number431505
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: