Provider Demographics
NPI:1932214269
Name:ALLARD, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ALLARD
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 1:304 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6829
Mailing Address - Country:US
Mailing Address - Phone:405-974-1376
Mailing Address - Fax:
Practice Address - Street 1:351 N AIR DEPOT BLVD STE X
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-1760
Practice Address - Country:US
Practice Address - Phone:405-732-1766
Practice Address - Fax:405-732-4337
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
OK1037225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1037OtherLICENSE #