MEDICARE: MINDY KARYL MCCOY 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	225XP0200X	Pediatric Occupational Therapist	1851	OK

General Provider Information

NPI Number	:	1699190595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY KARYL MCCOY OTR/L

Provider Business Mailing Address
First Line	:	2208 W DETROIT ST
Second Line	:	STE 208
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-3630
Country	:	US
Telephone Number	:	918-806-0106
Fax Number	:	918-806-0113

Provider Business Practice Location Address
First Line	:	7256 CR 2145
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003
Country	:	US
Telephone Number	:	918-899-3134
Fax Number	:

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

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	02/28/2014

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