Provider Demographics
NPI:1386721322
Name:VAUSE-EARLAND, TRACEY (OTRL)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:VAUSE-EARLAND
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S 9TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5233
Mailing Address - Country:US
Mailing Address - Phone:215-503-6791
Mailing Address - Fax:215-923-2475
Practice Address - Street 1:130 S 9TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5233
Practice Address - Country:US
Practice Address - Phone:215-503-6791
Practice Address - Fax:215-923-2475
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000584L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ164394Medicare PIN
PA096565Medicare PIN