Provider Demographics
NPI:1114646312
Name:TRACEY, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TRACEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5378 TOWNSHIP ROAD 127
Mailing Address - Street 2:
Mailing Address - City:ZANESFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43360-9748
Mailing Address - Country:US
Mailing Address - Phone:937-935-2192
Mailing Address - Fax:
Practice Address - Street 1:5378 TOWNSHIP ROAD 127
Practice Address - Street 2:
Practice Address - City:ZANESFIELD
Practice Address - State:OH
Practice Address - Zip Code:43360-9748
Practice Address - Country:US
Practice Address - Phone:937-935-2192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care