Healthcare Provider Details

I. General information

NPI: 1073381182
Provider Name (Legal Business Name): TRACY LYNN CARRASCO OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 W GORE ST FL 3
ORLANDO FL
32806-1134
US

IV. Provider business mailing address

2450 DAHLGREN WAY FL 34787
WINTER GARDEN FL
34787-5491
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3220
  • Fax:
Mailing address:
  • Phone: 407-927-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT5814
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: