Individual
MRS. TRACY ANNE MARLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
362 COLUMBUS AVE, PAWTUCKET, RI 02861-3442
(401) 480-3437
Mailing address
362 COLUMBUS AVE, PAWTUCKET, RI 02861-3442
(401) 480-3437
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3391
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3391
MA. OCCUPATIONAL THERAPY ASST LICENSE
MA
Enumeration date
01/31/2013
Last updated
01/31/2013
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