Individual
MRS. KELLY MARIE MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
15476 DEDEAUX RD., SUITE B, GULFPORT, MS 39503
(228) 679-3001
(228) 679-3039
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
OT3034
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700858826
—
NV
Enumeration date
02/02/2006
Last updated
08/26/2024
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