Provider Demographics
NPI:1629558184
Name:TRACY, ABIGAIL KYMER-DAVIS
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:KYMER-DAVIS
Last Name:TRACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 NEWELL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-7048
Mailing Address - Country:US
Mailing Address - Phone:501-831-2827
Mailing Address - Fax:
Practice Address - Street 1:5175 EMERALD PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1063
Practice Address - Country:US
Practice Address - Phone:501-831-2827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9177235Z00000X
OHSP.13776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist