Provider Demographics
NPI:1326438342
Name:TRACY, CHRISTINA (OTL)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LINCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9157
Mailing Address - Country:US
Mailing Address - Phone:614-218-6050
Mailing Address - Fax:
Practice Address - Street 1:101 LINCLIFF DR
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9157
Practice Address - Country:US
Practice Address - Phone:614-218-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-05045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist