MEDICARE: TRACY ANN EGGE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056005855	IL

General Provider Information

NPI Number	:	1336735844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY ANN EGGE OTR/L

Provider Business Mailing Address
First Line	:	1442 BLUE HERON DR
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-1970
Country	:	US
Telephone Number	:	847-331-4496
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 IL ROUTE 176
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-2145
Country	:	US
Telephone Number	:	815-459-3023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	12/18/2020

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