Provider Demographics
NPI:1083025480
Name:KLINE, TRACI LYNN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:LYNN
Last Name:KLINE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 E TRESSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9272
Mailing Address - Country:US
Mailing Address - Phone:570-523-4226
Mailing Address - Fax:570-768-4791
Practice Address - Street 1:189 E TRESSLER BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9272
Practice Address - Country:US
Practice Address - Phone:570-523-4226
Practice Address - Fax:570-768-4791
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006155224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant