Provider Demographics
NPI:1104390749
Name:MARSH, TRACY LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:MARSH
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 1:112 FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4226
Mailing Address - Country:US
Mailing Address - Phone:860-508-0028
Mailing Address - Fax:
Practice Address - Street 1:24 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6359
Practice Address - Country:US
Practice Address - Phone:617-223-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11124225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist