Provider Demographics
NPI:1558170449
Name:ZELENSKE, TRACEY ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:ZELENSKE
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 1:6021 TOLMAN CIR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-8842
Mailing Address - Country:US
Mailing Address - Phone:540-537-5419
Mailing Address - Fax:
Practice Address - Street 1:200 THE GLEBE BLVD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3722
Practice Address - Country:US
Practice Address - Phone:540-591-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000468224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant