Provider Demographics
NPI:1861452484
Name:FUTRELL, TRACY HYDE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:HYDE
Last Name:FUTRELL
Suffix:
Gender:F
Credentials: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:PO BOX 8498
Mailing Address - Street 2:2413 PROFESSIONAL DRIVE
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1498
Mailing Address - Country:US
Mailing Address - Phone:252-443-6627
Mailing Address - Fax:252-443-0709
Practice Address - Street 1:2413 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2254
Practice Address - Country:US
Practice Address - Phone:252-443-6627
Practice Address - Fax:252-443-0709
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4242225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist