Individual
TRACY CHILDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3603 RIVERVIEW RD, METROPOLIS, IL 62960-6624
(270) 853-0427
Mailing address
3603 RIVERVIEW RD, METROPOLIS, IL 62960-6624
(270) 853-0427
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
166021
KY
Other
Enumeration date
11/29/2016
Last updated
11/29/2016
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