Provider Demographics
NPI:1437473824
Name:DEVERS, TRACI GAIL (COTA)
Entity Type:Individual
Prefix:MISS
First Name:TRACI
Middle Name:GAIL
Last Name:DEVERS
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 1:2817 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-2540
Mailing Address - Country:US
Mailing Address - Phone:812-303-7411
Mailing Address - Fax:
Practice Address - Street 1:2119 E NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4507
Practice Address - Country:US
Practice Address - Phone:812-254-3301
Practice Address - Fax:812-257-0039
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001738A224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification