Provider Demographics
NPI:1073863858
Name:CHITWOOD, TRACEY (MPH OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:CHITWOOD
Suffix:
Gender:F
Credentials:MPH OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-2813
Mailing Address - Country:US
Mailing Address - Phone:423-383-7037
Mailing Address - Fax:
Practice Address - Street 1:452 BROOKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2813
Practice Address - Country:US
Practice Address - Phone:423-383-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist