Individual
TRACY DUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1211 W LIMA ST, SUITE A, KENTON, OH 43326-8846
(419) 674-2288
Mailing address
1211 W LIMA ST, SUITE A, KENTON, OH 43326-8846
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OH3129745
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70604895
—
OH
Enumeration date
09/10/2014
Last updated
09/10/2014
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