Provider Demographics
NPI:1215352489
Name:JAGER, TRACIE (MT)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:
Last Name:JAGER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28929 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:GIBRALTAR
Mailing Address - State:MI
Mailing Address - Zip Code:48173-9729
Mailing Address - Country:US
Mailing Address - Phone:734-479-5009
Mailing Address - Fax:
Practice Address - Street 1:3939 VAN HORN RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4013
Practice Address - Country:US
Practice Address - Phone:734-306-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist