MEDICARE: TRACEE TSAI 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
2	225XG0600X	Gerontology Occupational Therapist	9384

General Provider Information

NPI Number	:	1467110254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEE TSAI OTR/L

Provider Business Mailing Address
First Line	:	53 LAKEVIEW
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-3628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 SUPERIOR AVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3628
Country	:	US
Telephone Number	:	949-646-7764
Fax Number	:

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

Provider Enumeration Date	:	11/30/2021
Last Update Date	:	11/30/2021

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