Provider Demographics
NPI:1689942427
Name:BERRY, TRACY RENEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:RENEE
Last Name:BERRY
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 1:4600 BUSINESS PARK BLVD # D24
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7142
Mailing Address - Country:US
Mailing Address - Phone:907-561-1478
Mailing Address - Fax:888-552-1720
Practice Address - Street 1:4600 BUSINESS PARK BLVD # D24
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7142
Practice Address - Country:US
Practice Address - Phone:907-561-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1439225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1577369Medicaid