Provider Demographics
NPI:1013020973
Name:WEST-STALLARD, TRACY L (OTR/L, HTC, PAM)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:WEST-STALLARD
Suffix:
Gender:F
Credentials:OTR/L, HTC, PAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SIERRA PARK RD
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-2073
Mailing Address - Country:US
Mailing Address - Phone:760-934-3311
Mailing Address - Fax:775-883-7742
Practice Address - Street 1:162 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3415
Practice Address - Country:US
Practice Address - Phone:760-872-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2814225X00000X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist