Basic Information
| Provider Information | |||||||||
| NPI: | 1487800827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRACY | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | |||||||||
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| Credential: | OT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LIEB HARVEY | ||||||||
| OtherFirstName: | TERESA | ||||||||
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| OtherCredential: | OT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 20410 CENTURY BLVD | ||||||||
| Address2: | NRH REGIONAL REHAB - SUITE 215 | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208741186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015406140 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12140 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | MITCHELLVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207211932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015406140 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 07/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 01861 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.