Provider Demographics
NPI:1285880211
Name:ANTHONY, TRACY BETH (COTA/L)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:BETH
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4588 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16134-4714
Mailing Address - Country:US
Mailing Address - Phone:724-932-3527
Mailing Address - Fax:
Practice Address - Street 1:486 SOUTH MAIN STREET
Practice Address - Street 2:AVRC
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003
Practice Address - Country:US
Practice Address - Phone:440-293-4226
Practice Address - Fax:440-293-6079
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02854172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker