MEDICARE: NANCY L. MCCORMICK OTR/L

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	225X00000X	Occupational Therapist	OT0591	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457682015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY L. MCCORMICK OTR/L

Provider Business Mailing Address
First Line	:	1275 US HIGHWAY 1
Second Line	:	SUITE 2 , BOX 119
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5783
Country	:	US
Telephone Number	:	954-914-4063
Fax Number	:	772-492-9953

Provider Business Practice Location Address
First Line	:	1275 US HIGHWAY 1
Second Line	:	SUITE 2, BOX 119
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5783
Country	:	US
Telephone Number	:	954-914-4063
Fax Number	:	772-492-9953

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

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	01/09/2015

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