Healthcare Provider Details

I. General information

NPI: 1700039591
Provider Name (Legal Business Name): TRACY A FELTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10248 PIONEER RD
BYESVILLE OH
43723-9676
US

IV. Provider business mailing address

10248 PIONEER RD
BYESVILLE OH
43723-9676
US

V. Phone/Fax

Practice location:
  • Phone: 740-297-1323
  • Fax:
Mailing address:
  • Phone: 740-297-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number02111
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: