Provider Demographics
NPI:1174290480
Name:MCCOY, TARRAH SUZANNE
Entity type:Individual
Prefix:
First Name:TARRAH
Middle Name:SUZANNE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 PULEO DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-8444
Mailing Address - Country:US
Mailing Address - Phone:614-354-3730
Mailing Address - Fax:
Practice Address - Street 1:380 PULEO DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-8444
Practice Address - Country:US
Practice Address - Phone:614-354-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker