Provider Demographics
NPI:1215264643
Name:DEGROW, TRACI ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:ANN
Last Name:DEGROW
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 1:143 MERRIMON AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1815
Mailing Address - Country:US
Mailing Address - Phone:828-254-8889
Mailing Address - Fax:828-254-8887
Practice Address - Street 1:143 MERRIMON AVE
Practice Address - Street 2:STE. A
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1815
Practice Address - Country:US
Practice Address - Phone:828-254-8889
Practice Address - Fax:828-254-8887
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7367225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics