MEDICARE: MRS. TRACIE LEANNE BINGMAN 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	KY-R3287	KY

General Provider Information

NPI Number	:	1619229432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACIE LEANNE BINGMAN OTR/L

Provider Business Mailing Address
First Line	:	813 VERMILLION PEAK PASS
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-6358
Country	:	US
Telephone Number	:	859-489-0141
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 VERMILLION PEAK PASS
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-6358
Country	:	US
Telephone Number	:	859-489-0141
Fax Number	:

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

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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