=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326016973
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY L FORRESTER MS, CCC-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2006
-----------------------------------------------------
Last Update Date | 03/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 PLEASANT ST
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01609-1858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-791-6310
-----------------------------------------------------
Fax | 508-791-6309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 EAGLE DR
-----------------------------------------------------
City | DUDLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01571-6025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-949-6810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 703
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231HA2500X
-----------------------------------------------------
Taxonomy Name | Assistive Technology Supplier Audiologist
-----------------------------------------------------
License Number | 703
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------