Provider Demographics
NPI:1336527357
Name:PAVLETICH, TRACI (OT)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:PAVLETICH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S SUNNY SLOPE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-7060
Mailing Address - Country:US
Mailing Address - Phone:414-805-9600
Mailing Address - Fax:414-805-9645
Practice Address - Street 1:1350 S SUNNY SLOPE RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-7060
Practice Address - Country:US
Practice Address - Phone:414-805-9600
Practice Address - Fax:414-805-9645
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1207225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist