Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00654300 | NJ |
N | 225XP0200X | Occupational Therapist - Pediatrics | 017830 | NY |
NPI | 1023359692 |
---|---|
Provider Name | Mrs. Tracy Ann Loncke |
First Address | Piscataway, NJ 08854-3175 |
Second Address | Piscataway, NJ 08854-3175 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2013 |
Last Update Date | 26/01/2015 |