Individual
TRACY THOMPSON FITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 E PICKWICK DR, SYRACUSE, IN 46567-2032
(574) 551-4704
Mailing address
9299 E PONDEROSA DR, NORTH WEBSTER, IN 46555-9557
(574) 551-4704
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001026A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320001026A
—
IN
Enumeration date
11/04/2022
Last updated
11/04/2022
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