Healthcare Provider Details

I. General information

NPI: 1003040908
Provider Name (Legal Business Name): TRACY M BOTTONE MSOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 EDUCATION DR
BEACON NY
12508-4066
US

IV. Provider business mailing address

10 EDUCATION DR
BEACON NY
12508-4066
US

V. Phone/Fax

Practice location:
  • Phone: 845-838-6900
  • Fax:
Mailing address:
  • Phone: 845-838-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number015033-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: