Provider Demographics
NPI:1134999469
Name:TRACY, MARIANNE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:TRACY
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 1:76 NORTHEASTERN BLVD STE 40
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3174
Mailing Address - Country:US
Mailing Address - Phone:603-882-4500
Mailing Address - Fax:
Practice Address - Street 1:76 NORTHEASTERN BLVD STE 40
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3174
Practice Address - Country:US
Practice Address - Phone:603-882-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3497225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist