Provider Demographics
NPI:1083828321
Name:DALTON, TRACEY (LOTR)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 METAIRIE LAWN DR
Mailing Address - Street 2:#315-14
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6171
Mailing Address - Country:US
Mailing Address - Phone:504-833-1232
Mailing Address - Fax:
Practice Address - Street 1:2601 METAIRIE LAWN DR
Practice Address - Street 2:#315-14
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6171
Practice Address - Country:US
Practice Address - Phone:504-833-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1623997Medicaid