Provider Demographics
NPI:1770908329
Name:TAUFERNER, TRACI (LAT)
Entity type:Individual
Prefix:MS
First Name:TRACI
Middle Name:
Last Name:TAUFERNER
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:SMET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT
Mailing Address - Street 1:5412 US HIGHWAY 10 E
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-8559
Mailing Address - Country:US
Mailing Address - Phone:715-346-5423
Mailing Address - Fax:
Practice Address - Street 1:5412 US HIGHWAY 10 E
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8559
Practice Address - Country:US
Practice Address - Phone:715-346-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI950-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI950-39OtherWI STATE LICENSE