Provider Demographics
NPI:1578798120
Name:BOZARD, TREACY BAKER (OTR/L)
Entity Type:Individual
Prefix:
First Name:TREACY
Middle Name:BAKER
Last Name:BOZARD
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 1:301 SLIDING HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-1730
Mailing Address - Country:US
Mailing Address - Phone:843-921-4884
Mailing Address - Fax:
Practice Address - Street 1:301 SLIDING HILL RD
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-1730
Practice Address - Country:US
Practice Address - Phone:843-921-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2202225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics