Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3649 | MA |
NPI | 1013336924 |
---|---|
Provider Name | Mrs. Krista Tracey |
First Address | Warwick, RI 02888-4423 |
Second Address | Warwick, RI 02888-4423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 08/04/2014 |