Healthcare Provider Details

I. General information

NPI: 1629347935
Provider Name (Legal Business Name): TRACEY MEREDITH BOOROM MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WOLF CREEK TRL
BROOMFIELD CO
80020-9693
US

IV. Provider business mailing address

150 WOLF CREEK TRL
BROOMFIELD CO
80020-9693
US

V. Phone/Fax

Practice location:
  • Phone: 516-643-8406
  • Fax:
Mailing address:
  • Phone: 516-643-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number8190
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: