Provider Demographics
NPI:1750941514
Name:TRACY, MORGAN (OTD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-1753
Mailing Address - Country:US
Mailing Address - Phone:715-741-0306
Mailing Address - Fax:
Practice Address - Street 1:411 PRAIRIE HEIGHTS DR STE 101
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-2238
Practice Address - Country:US
Practice Address - Phone:608-556-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist