MEDICARE: LINDA TRACY, OTR/L, PC

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
1	174400000X	Specialist	OT97	OK

General Provider Information

NPI Number	:	1306946843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDA TRACY, OTR/L, PC

Provider Business Mailing Address
First Line	:	21047 S 205TH EAST AVE
Second Line	:
City	:	HASKELL
State	:	OK
Zip	:	74436-2259
Country	:	US
Telephone Number	:	918-724-0588
Fax Number	:	918-482-1484

Provider Business Practice Location Address
First Line	:	21047 S 205TH EAST AVE
Second Line	:
City	:	HASKELL
State	:	OK
Zip	:	74436-2259
Country	:	US
Telephone Number	:	918-724-0588
Fax Number	:	918-482-1484

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LINDA TRACY
Credential	:	OTR
Telephone Number	:	918-724-0588

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	08/22/2020

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