Provider Demographics
NPI:1992152540
Name:URBANSOK, TRACEY A (OTR/L)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:A
Last Name:URBANSOK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N FERN ABBEY LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8981
Mailing Address - Country:US
Mailing Address - Phone:919-647-4763
Mailing Address - Fax:
Practice Address - Street 1:111 N FERN ABBEY LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8981
Practice Address - Country:US
Practice Address - Phone:919-647-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-007156225X00000X
NY46TR00721100225X00000X
DC0T010001536225X00000X
NJ020049225X00000X
NC14705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist