Individual
MR. TRACY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.T.
Contact information
Practice address
90 CLARK AVE # A, TUPELO, MS 38804-2801
(662) 840-0535
(662) 842-7915
Mailing address
15 STARLING CRK, BOONEVILLE, MS 38829-3638
(662) 416-3283
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1457
MS
Other
Enumeration date
12/29/2006
Last updated
07/08/2007
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