Individual
MRS. TRACEY M BACKUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
10043 IDLEWILD RD, MATTHEWS, NC 28105-2013
(704) 545-0009
Mailing address
10645 STONE BUNKER DR, MINT HILL, NC 28227-7036
(704) 575-3765
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2495
NC
Other
Enumeration date
05/28/2011
Last updated
05/28/2011
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