Provider Demographics
NPI:1770701435
Name:SCHULTZE, TRACY M (COTA)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:M
Last Name:SCHULTZE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 N CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1113
Mailing Address - Country:US
Mailing Address - Phone:480-226-8132
Mailing Address - Fax:
Practice Address - Street 1:3203 N CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1113
Practice Address - Country:US
Practice Address - Phone:480-226-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3712171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor