Provider Demographics
NPI:1851712913
Name:CAGLE, TRACY (MA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CAGLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:WINLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98596-9303
Mailing Address - Country:US
Mailing Address - Phone:360-880-7719
Mailing Address - Fax:
Practice Address - Street 1:566 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:WINLOCK
Practice Address - State:WA
Practice Address - Zip Code:98596-9303
Practice Address - Country:US
Practice Address - Phone:360-880-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WAMA60423213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist