Provider Demographics
NPI:1588238638
Name:CLIXBY, TRACY LYNN (COTA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:CLIXBY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:2637 124TH ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-2238
Mailing Address - Country:US
Mailing Address - Phone:419-699-1501
Mailing Address - Fax:
Practice Address - Street 1:2637 124TH ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-2238
Practice Address - Country:US
Practice Address - Phone:419-699-1501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.06219224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant