Individual
TRACY LIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
2508 BROOKGATE WAY, ELLENWOOD, GA 30294-2390
(404) 957-5015
Mailing address
4093 VILLAGEWOOD LN, ELLENWOOD, GA 30294-5721
(404) 957-5015
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003590
GA
225XP0200X
Pediatric Occupational Therapist
OT005980
GA
Other
Enumeration date
08/26/2016
Last updated
09/12/2024
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