Provider Demographics
NPI:1306132451
Name:MCCORMICK, DANA LYMM (OT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LYMM
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 COVE LANDING RD APT 102
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4724
Mailing Address - Country:US
Mailing Address - Phone:571-437-6347
Mailing Address - Fax:
Practice Address - Street 1:5912 COVE LANDING RD APT 102
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4724
Practice Address - Country:US
Practice Address - Phone:571-437-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003508225X00000X
FL11984225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist