MEDICARE: KALEAH MCCOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	104989	FL

General Provider Information

NPI Number	:	1184516585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALEAH MCCOY

Provider Business Mailing Address
First Line	:	264 SW OLD NIBLACK AVE
Second Line	:
City	:	FORT WHITE
State	:	FL
Zip	:	32038-3278
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 SW OLD NIBLACK AVE
Second Line	:
City	:	FORT WHITE
State	:	FL
Zip	:	32038-3278
Country	:	US
Telephone Number	:	352-389-9367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	07/18/2025

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Directions to “ KALEAH MCCOY ” Practice Location

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