Provider Demographics
NPI:1831705425
Name:RAWLINGS, TRACI S
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:S
Last Name:RAWLINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2866 REED RD
Mailing Address - Street 2:
Mailing Address - City:SABINA
Mailing Address - State:OH
Mailing Address - Zip Code:45169-9073
Mailing Address - Country:US
Mailing Address - Phone:937-218-8655
Mailing Address - Fax:
Practice Address - Street 1:2866 REED RD
Practice Address - Street 2:
Practice Address - City:SABINA
Practice Address - State:OH
Practice Address - Zip Code:45169-9073
Practice Address - Country:US
Practice Address - Phone:937-218-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2315846Medicaid