Provider Demographics
NPI:1396939377
Name:MCGUIRE, TRACI LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:MCGUIRE
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 1:5901 E FOWLER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2305
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:813-247-4480
Practice Address - Street 1:2044 TRINITY OAKS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4405
Practice Address - Country:US
Practice Address - Phone:813-978-7000
Practice Address - Fax:813-558-6185
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 004735225X00000X
FLOT19656225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4224312Medicare PIN
OH4224311Medicare PIN