Provider Demographics
NPI:1376232488
Name:D'AMICO, TRACEY MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:MARIE
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DON AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-2316
Mailing Address - Country:US
Mailing Address - Phone:508-247-7655
Mailing Address - Fax:
Practice Address - Street 1:15 SUMNER BROWN RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1297
Practice Address - Country:US
Practice Address - Phone:401-333-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist