Provider Demographics
NPI:1811252927
Name:BARTHOLOMEW, TRACEY LYNN (OT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 10TH AVE NE
Mailing Address - Street 2:DEER RIVER HEALTHCARE CENTER
Mailing Address - City:DEER RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:56636-8795
Mailing Address - Country:US
Mailing Address - Phone:218-246-2900
Mailing Address - Fax:
Practice Address - Street 1:115 10TH AVE NE
Practice Address - Street 2:DEER RIVER HEALTHCARE CENTER
Practice Address - City:DEER RIVER
Practice Address - State:MN
Practice Address - Zip Code:56636-8795
Practice Address - Country:US
Practice Address - Phone:218-246-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103753225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist