Provider Demographics
NPI:1124582531
Name:STEIN, TRACEY KARYN
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:KARYN
Last Name:STEIN
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 1:6623 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2849
Mailing Address - Country:US
Mailing Address - Phone:469-693-7572
Mailing Address - Fax:
Practice Address - Street 1:14160 DALLAS PKWY STE 415
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-4356
Practice Address - Country:US
Practice Address - Phone:972-385-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110364225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics