Provider Demographics
NPI:1760416937
Name:TYLER, TRACI ANN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:ANN
Last Name:TYLER
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-0339
Mailing Address - Country:US
Mailing Address - Phone:847-639-0537
Mailing Address - Fax:847-639-1020
Practice Address - Street 1:425 CARY WOODS CIR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2059
Practice Address - Country:US
Practice Address - Phone:773-255-7503
Practice Address - Fax:847-639-1020
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics