MEDICARE: LAUREN TRACY

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	10229	NC
2	225X00000X	Occupational Therapist	5519	TN

General Provider Information

NPI Number	:	1922554864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN TRACY

Provider Business Mailing Address
First Line	:	3130 LOWNDES DR
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 LOWNDES DR
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2922
Country	:	US
Telephone Number	:	407-766-3259
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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Directions to “ LAUREN TRACY ” Practice Location

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