Provider Demographics
NPI:1528766748
Name:MOTT-GOODMAN, TRACY L
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:L
Last Name:MOTT-GOODMAN
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 1:30 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-4218
Mailing Address - Country:US
Mailing Address - Phone:216-308-0005
Mailing Address - Fax:
Practice Address - Street 1:108 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-4104
Practice Address - Country:US
Practice Address - Phone:440-725-9810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider