Provider Demographics
NPI:1730643602
Name:JONES, TRACY LYNN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:SCHONDELMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1700 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413-1013
Mailing Address - Country:US
Mailing Address - Phone:330-426-2920
Mailing Address - Fax:
Practice Address - Street 1:100 COVINGTON DR
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413-1007
Practice Address - Country:US
Practice Address - Phone:330-426-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-01417224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant