Provider Demographics
NPI:1952415234
Name:FINKEN, TRACEE LANE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TRACEE
Middle Name:LANE
Last Name:FINKEN
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 1:15915 RESTON BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6907
Mailing Address - Country:US
Mailing Address - Phone:281-256-0404
Mailing Address - Fax:281-256-0404
Practice Address - Street 1:15915 RESTON BRIDGE DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6907
Practice Address - Country:US
Practice Address - Phone:281-256-0404
Practice Address - Fax:281-256-0404
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103607225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX659646OtherBCBS NUMBER
TX8T6353OtherBCBS NUMBER