MEDICARE: DAVID MCEVOY OTR

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	016117	NY

General Provider Information

NPI Number	:	1528224540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MCEVOY OTR

Provider Business Mailing Address
First Line	:	3 PURPLE HEART WAY
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-1634
Country	:	US
Telephone Number	:	845-769-5074
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 PURPLE HEART WAY
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-1634
Country	:	US
Telephone Number	:	845-769-5074
Fax Number	:

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

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/03/2012

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