Individual
TRACY WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7367 SPOUT SPRINGS RD, SUITE 125, FLOWERY BRANCH, GA 30542-5519
(770) 965-1861
(770) 965-1863
Mailing address
7367 SPOUT SPRINGS RD, SUITE 125, FLOWERY BRANCH, GA 30542-5519
(770) 965-1861
(770) 965-1863
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT005968
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT005968
GA SECRETARY OF STATE LICENSING BOARD
—
Enumeration date
10/20/2014
Last updated
10/20/2014
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