Provider Demographics
NPI:1467442376
Name:ZINSER-BOURNE, TRACY A (OTR/L,CHT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:ZINSER-BOURNE
Suffix:
Gender:F
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 MCKEEVER PIKE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-9559
Mailing Address - Country:US
Mailing Address - Phone:513-724-7122
Mailing Address - Fax:
Practice Address - Street 1:545 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3444
Practice Address - Country:US
Practice Address - Phone:859-331-4263
Practice Address - Fax:859-344-1711
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR0613225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8800045000Medicaid
KY8800045000Medicaid