Healthcare Provider Details

I. General information

NPI: 1982042420
Provider Name (Legal Business Name): TRACI MCGRATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 JOHN ST
WESTON WV
26452-2269
US

IV. Provider business mailing address

112 KINGSBURY CT
FAIRMONT WV
26554-2259
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-7711
  • Fax: 866-426-2811
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1697
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: