Provider Demographics
NPI:1841579794
Name:AUGUSTINE, TRACY G (OTR/L, CHT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:G
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4753
Mailing Address - Country:US
Mailing Address - Phone:614-461-8174
Mailing Address - Fax:614-461-9155
Practice Address - Street 1:323 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4753
Practice Address - Country:US
Practice Address - Phone:614-461-8174
Practice Address - Fax:614-461-9155
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-004240225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand