Individual
MRS. KARY TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
210 LAKE RD, LAKE JACKSON, TX 77566-4982
(979) 258-7247
(979) 258-7247
Mailing address
210 LAKE RD STE 500, LAKE JACKSON, TX 77566-4982
(979) 258-7230
(979) 258-7247
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
110745
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091740301
—
TX
01
—
8F8504
MEDICARE PTAN
TX
01
—
8T1101
BCBS
TX
Enumeration date
01/25/2006
Last updated
04/28/2022
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