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NPI Code Detail

MEDICARE: TRACY RALICKI OTR

MEDICARE: TRACY RALICKI OTR
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
1225XG0600XGerontology Occupational Therapist5201000385MI

General Provider Information

NPI Number : 1659877512
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY RALICKI OTR
Provider Business Mailing Address
First Line : 120 BASELINE RD
Second Line :
City : SOUTH HAVEN
State : MI
Zip : 49090-1037
Country : US
Telephone Number : 269-637-8411
Fax Number :
Provider Business Practice Location Address
First Line : 120 BASELINE RD
Second Line :
City : SOUTH HAVEN
State : MI
Zip : 49090-1037
Country : US
Telephone Number : 269-637-8411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2018
Last Update Date : 03/31/2018

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Directions to “ TRACY RALICKI OTR” Practice Location

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