Provider Demographics
NPI:1609331818
Name:NAFTALY, TRACY MICHELE (OT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MICHELE
Last Name:NAFTALY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 E SPRUCE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3378
Mailing Address - Country:US
Mailing Address - Phone:559-433-4700
Mailing Address - Fax:
Practice Address - Street 1:1360 E SPRUCE AVE
Practice Address - Street 2:103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3378
Practice Address - Country:US
Practice Address - Phone:559-433-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18670225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics