Provider Demographics
NPI:1992454276
Name:STOWERS, TRACY (OTR/L)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:STOWERS
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 1:4565 COMMERCIAL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-8856
Mailing Address - Country:US
Mailing Address - Phone:850-353-2415
Mailing Address - Fax:
Practice Address - Street 1:4565 COMMERCIAL DR STE 105
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8856
Practice Address - Country:US
Practice Address - Phone:850-353-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT22827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist