Provider Demographics
NPI:1538469523
Name:DUMKE, TRACY (OTR)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:DUMKE
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 1:825 WALTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073
Mailing Address - Country:US
Mailing Address - Phone:920-892-4322
Mailing Address - Fax:
Practice Address - Street 1:825 WALTON DRIVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073
Practice Address - Country:US
Practice Address - Phone:920-892-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4097-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist