Individual
JESSICA ALICIA TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1520 GROVE ST, LOUDON, TN 37774-1575
(865) 458-5436
Mailing address
113 NEBRASKA AVE, OAK RIDGE, TN 37830-8143
(505) 604-4368
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3076
TN
Other
Enumeration date
09/13/2023
Last updated
09/13/2023
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