Provider Demographics
NPI:1558644500
Name:ROGER, TRACY LEE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LEE
Last Name:ROGER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 LORRAINE DR
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1203
Mailing Address - Country:US
Mailing Address - Phone:845-876-4364
Mailing Address - Fax:
Practice Address - Street 1:49 LORRAINE DR
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1203
Practice Address - Country:US
Practice Address - Phone:845-876-4364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010351-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist