Provider Demographics
NPI:1346508371
Name:DELTORO, TRACY (COTA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:DELTORO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 BIRCH PLACE
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-3331
Mailing Address - Country:US
Mailing Address - Phone:832-233-1903
Mailing Address - Fax:
Practice Address - Street 1:5177 RICHMOND AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6707
Practice Address - Country:US
Practice Address - Phone:832-900-2770
Practice Address - Fax:832-201-8489
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209145224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant