MEDICARE: ELIZABETH J MCCOY O.T.

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	0119002847	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6700001706	OTHER	VA	RAILROAD MEDICARE PROV NU

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	195326	OTHER	VA	ANTHEM PROVIDER NUMBER

General Provider Information

NPI Number	:	1821095043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH J MCCOY O.T.

Provider Business Mailing Address
First Line	:	PO BOX 136
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-0136
Country	:	US
Telephone Number	:	540-962-6226
Fax Number	:	540-962-7447

Provider Business Practice Location Address
First Line	:	320 W MAIN ST
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-1517
Country	:	US
Telephone Number	:	540-962-6226
Fax Number	:	540-962-7447

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/09/2007

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