Provider Demographics
NPI:1790449411
Name:GROB, TRACY SUE (OT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:SUE
Last Name:GROB
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 1:5600 OLD MILE HILL RD
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-2274
Mailing Address - Country:US
Mailing Address - Phone:610-751-1634
Mailing Address - Fax:
Practice Address - Street 1:5600 OLD MILE HILL RD
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2274
Practice Address - Country:US
Practice Address - Phone:610-751-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003674L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist