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General NPI Number Information
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NPI Number | 1376777300
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Entity Type | Individual
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Provider Name | TRACY ANN HIGGINS
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Gender | Female
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 2171 JERICHO TPKE 340
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City | COMMACK
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State | NY
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Zip | 11725-2937
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Country | US
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Telephone | 631-499-5595
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Fax |
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Provider Business Mailing Address
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Address Line | 300 3RD AVE
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-3410
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Country | US
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Telephone | 631-368-4343
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0076121
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License Number State | NY
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