Provider Demographics
NPI:1104379031
Name:PEPIN, TRACI N (OTR/L)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:N
Last Name:PEPIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:N
Other - Last Name:GUILD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 E BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3435
Mailing Address - Country:US
Mailing Address - Phone:319-352-4544
Mailing Address - Fax:
Practice Address - Street 1:217 E BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3435
Practice Address - Country:US
Practice Address - Phone:319-352-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist