Provider Demographics
NPI:1851530422
Name:MCSHEA, TRACY LYNN (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:MCSHEA
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 1:475 OLD MARLTON PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-983-6160
Mailing Address - Fax:
Practice Address - Street 1:475 OLD MARLTON PIKE W
Practice Address - Street 2:SUITE 1
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2098
Practice Address - Country:US
Practice Address - Phone:856-983-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00277000225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics