Provider Demographics
NPI:1841685872
Name:CARLSON, TRACI (OTR)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16679 NW NORWALK DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5280
Mailing Address - Country:US
Mailing Address - Phone:503-332-8131
Mailing Address - Fax:
Practice Address - Street 1:16679 NW NORWALK DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5280
Practice Address - Country:US
Practice Address - Phone:503-332-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1070557225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist