Healthcare Provider Details

I. General information

NPI: 1598521254
Provider Name (Legal Business Name): TRACY LINDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 ATHERTON RD
DAYTON OH
45409-1205
US

IV. Provider business mailing address

3815 ELMIRA DR
DAYTON OH
45439-2412
US

V. Phone/Fax

Practice location:
  • Phone: 937-768-9663
  • Fax:
Mailing address:
  • Phone: 937-270-3598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: