Provider Demographics
NPI:1649438557
Name:DUNCAN, TRACEY LEE (OTRL)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LEE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 BERT JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-2414
Mailing Address - Country:US
Mailing Address - Phone:901-475-0027
Mailing Address - Fax:
Practice Address - Street 1:765 BERT JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-2414
Practice Address - Country:US
Practice Address - Phone:901-475-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist