Provider Demographics
NPI:1396915013
Name:VANDEVORDE, TRACY HELEN (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:HELEN
Last Name:VANDEVORDE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:HELEN
Other - Last Name:SCHALDENBRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:125 GREENE STREET
Mailing Address - Street 2:APT 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012
Mailing Address - Country:US
Mailing Address - Phone:248-505-0069
Mailing Address - Fax:847-723-4353
Practice Address - Street 1:318 EAST 116TH STREET
Practice Address - Street 2:ABC KEITH HARING SCHOOL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-426-3960
Practice Address - Fax:212-426-3961
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008265225XP0200X
NY019713225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics