Healthcare Provider Details

I. General information

NPI: 1316850456
Provider Name (Legal Business Name): TRACY J BORDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W TIFFIN ST
ATTICA OH
44807-9463
US

IV. Provider business mailing address

206 W TIFFIN ST
ATTICA OH
44807-9463
US

V. Phone/Fax

Practice location:
  • Phone: 567-224-1278
  • Fax:
Mailing address:
  • Phone: 567-224-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: