Provider Demographics
NPI:1861040677
Name:HENSLEY, TRACY DIANNE (OTR)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:DIANNE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11090 THRUSH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4722
Mailing Address - Country:US
Mailing Address - Phone:301-768-0082
Mailing Address - Fax:
Practice Address - Street 1:850 HUNGERFORD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1718
Practice Address - Country:US
Practice Address - Phone:301-309-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03990225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics