Provider Demographics
NPI:1801035399
Name:GRANT, TRACY (OTR/L)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:MACKINNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:186 PROVIDENCE ST
Mailing Address - Street 2:PO BOX 155
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-1321
Mailing Address - Country:US
Mailing Address - Phone:508-634-7957
Mailing Address - Fax:
Practice Address - Street 1:375 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1723
Practice Address - Country:US
Practice Address - Phone:508-478-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3999225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics