Provider Demographics
NPI:1942565049
Name:HARVEY, TRACEY JOANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:JOANNE
Last Name:HARVEY
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 1:465 HYLAND DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7245
Mailing Address - Country:US
Mailing Address - Phone:413-364-1948
Mailing Address - Fax:
Practice Address - Street 1:465 HYLAND DR
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7245
Practice Address - Country:US
Practice Address - Phone:413-364-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007134-1224Z00000X
PAOC013766225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist