Individual
TRACEY JOLYNN WHITESELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
5622 W STATE ROAD 340, BRAZIL, IN 47834-7867
(812) 249-4795
Mailing address
5622 W STATE ROAD 340, BRAZIL, IN 47834-7867
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31005065A
IN
Other
Enumeration date
02/21/2025
Last updated
02/21/2025
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