Provider Demographics
NPI:1215100052
Name:HAYMON, TRACY RENEE (OTR)
Entity type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:RENEE
Last Name:HAYMON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3300
Mailing Address - Country:US
Mailing Address - Phone:219-924-0007
Mailing Address - Fax:
Practice Address - Street 1:2366 ELLSWORTH ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3300
Practice Address - Country:US
Practice Address - Phone:219-924-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004576A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist