Provider Demographics
NPI:1164158762
Name:TONNIGES, TRACIE LYNN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:LYNN
Last Name:TONNIGES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:TRACIE
Other - Middle Name:LYNN
Other - Last Name:TONNIGES-SOKOLIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:20178 NINA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-5082
Mailing Address - Country:US
Mailing Address - Phone:402-759-1531
Mailing Address - Fax:
Practice Address - Street 1:20178 NINA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-5082
Practice Address - Country:US
Practice Address - Phone:402-759-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE824225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist