Provider Demographics
NPI:1124269550
Name:TRYGG, TRACI LOUISE (OTR/L)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LOUISE
Last Name:TRYGG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16125 JUANITA WDVL WAY NE
Mailing Address - Street 2:UNIT 1105
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-6489
Mailing Address - Country:US
Mailing Address - Phone:206-724-7512
Mailing Address - Fax:
Practice Address - Street 1:702 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1803
Practice Address - Country:US
Practice Address - Phone:206-724-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-15
Last Update Date:2009-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist