Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003494535 |
---|---|
Provider Name | Olivia Tracey |
First Address | Oreland, PA 19075-1924 |
Second Address | Oreland, PA 19075-1924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2021 |
Last Update Date | 29/03/2021 |