Provider Demographics
NPI:1033241757
Name:D'ALTERIO, TRACEY LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:D'ALTERIO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-2125
Mailing Address - Country:US
Mailing Address - Phone:315-418-6006
Mailing Address - Fax:
Practice Address - Street 1:1001 W FAYETTE ST STE 5B
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2867
Practice Address - Country:US
Practice Address - Phone:315-425-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0058471225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist