Provider Demographics
NPI:1407156888
Name:DEMARIA, TRACEY LAINE (OTR)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LAINE
Last Name:DEMARIA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LOWER WAY RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-8036
Mailing Address - Country:US
Mailing Address - Phone:610-252-2914
Mailing Address - Fax:908-847-0389
Practice Address - Street 1:22 LOWER WAY RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8036
Practice Address - Country:US
Practice Address - Phone:610-252-2914
Practice Address - Fax:908-847-0389
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics