Provider Demographics
NPI:1578618872
Name:SOLANO, TRACY B (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:B
Last Name:SOLANO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:TEITLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:680 TENNIS CLUB DR
Mailing Address - Street 2:BROOKS 110
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-4059
Mailing Address - Country:US
Mailing Address - Phone:954-376-9653
Mailing Address - Fax:
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:BROWARD GENERAL MEDICAL CENTER- REHAB DEPT
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-5341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11806225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist