Provider Demographics
NPI:1467626747
Name:VAN OSS, TRACY (MPH, OTR/L, CHES)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:VAN OSS
Suffix:
Gender:F
Credentials:MPH, OTR/L, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 HARTFORD TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1247
Mailing Address - Country:US
Mailing Address - Phone:203-671-3060
Mailing Address - Fax:
Practice Address - Street 1:1604 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1247
Practice Address - Country:US
Practice Address - Phone:203-671-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001620225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist