MEDICARE: MARCIA K. MCCOY PTA

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	225200000X	Physical Therapy Assistant	04224	OH

General Provider Information

NPI Number	:	1194926618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA K. MCCOY PTA

Provider Business Mailing Address
First Line	:	16169 OLD MANSFIELD RD
Second Line	:
City	:	FREDERICKTOWN
State	:	OH
Zip	:	43019-9604
Country	:	US
Telephone Number	:	740-397-4664
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 AVALON RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1403
Country	:	US
Telephone Number	:	740-397-3200
Fax Number	:

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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