Provider Demographics
NPI:1285884643
Name:STACKHOUSE, TRACY M (MA, OTR)
Entity type:Individual
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First Name:TRACY
Middle Name:M
Last Name:STACKHOUSE
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Gender:F
Credentials:MA, OTR
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Mailing Address - Street 1:90 MADISON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5418
Mailing Address - Country:US
Mailing Address - Phone:303-333-8360
Mailing Address - Fax:303-333-8380
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5418
Practice Address - Country:US
Practice Address - Phone:303-333-8360
Practice Address - Fax:303-333-8380
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics