Provider Demographics
NPI:1285325530
Name:SALTER, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-3541
Mailing Address - Country:US
Mailing Address - Phone:561-234-6629
Mailing Address - Fax:
Practice Address - Street 1:1027 W 31ST ST
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-3541
Practice Address - Country:US
Practice Address - Phone:561-234-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services