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NPI Code Detail

MEDICARE: MS. TRACEY EDNA CARRIERE

MEDICARE: MS. TRACEY EDNA CARRIERE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist4670TN

General Provider Information

NPI Number : 1063757086
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACEY EDNA CARRIERE
Provider Business Mailing Address
First Line : 1720 STONE ST
Second Line : B22
City : UNION CITY
State : TN
Zip : 38261-6034
Country : US
Telephone Number : 731-885-8095
Fax Number :
Provider Business Practice Location Address
First Line : 1630 E REELFOOT AVE
Second Line :
City : UNION CITY
State : TN
Zip : 38261-6021
Country : US
Telephone Number : 731-885-8095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2012
Last Update Date : 12/03/2012

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Directions to “ MS. TRACEY EDNA CARRIERE ” Practice Location

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