Provider Demographics
NPI:1326157959
Name:CARLE-BOLANO, TRACY STEWART (OTR/L, LPTA)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:STEWART
Last Name:CARLE-BOLANO
Suffix:
Gender:F
Credentials:OTR/L, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 N COUNTRY CLUB DR
Mailing Address - Street 2:UNIT 402
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1669
Mailing Address - Country:US
Mailing Address - Phone:305-546-1598
Mailing Address - Fax:
Practice Address - Street 1:5931 NW 173 DR.
Practice Address - Street 2:UNIT 10
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:305-826-7884
Practice Address - Fax:305-826-1545
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12270225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist