=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215093372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABOVE & BEYOND OCCUPATIONAL THERAPY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 751 W 67TH ST
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74132-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-446-4068
-----------------------------------------------------
Fax | 918-446-4068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 751 W 67TH ST
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74132-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-446-4068
-----------------------------------------------------
Fax | 918-446-4068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANNE ELIZABETH MCCOY
-----------------------------------------------------
Credential | O.T.
-----------------------------------------------------
Telephone | 918-446-4068
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OT73
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------