Provider Demographics
NPI:1457682148
Name:PERRY, TRACI JANE (OT)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:JANE
Last Name:PERRY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27880 RIATA RANCH DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2517
Mailing Address - Country:US
Mailing Address - Phone:210-508-7309
Mailing Address - Fax:
Practice Address - Street 1:27880 RIATA RANCH DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-2517
Practice Address - Country:US
Practice Address - Phone:210-508-7309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist