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General NPI Number Information
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NPI Number | 1700858826
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Entity Type | Individual
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Provider Name | KELLY MARIE MCCOY OT
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Gender | Female
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 15476 DEDEAUX RD. SUITE B
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City | GULFPORT
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State | MS
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Zip | 39503
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Country | US
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Telephone | 228-679-3001
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Fax | 228-679-3039
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT3034
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License Number State | MS
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