Provider Demographics
NPI:1154036085
Name:RANGE, TRACI SUE (PTA)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:SUE
Last Name:RANGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9769 GRIST MILL RUN
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-2892
Mailing Address - Country:US
Mailing Address - Phone:440-263-8642
Mailing Address - Fax:
Practice Address - Street 1:9769 GRIST MILL RUN
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-2892
Practice Address - Country:US
Practice Address - Phone:440-263-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker