1144340688 NPI number — MRS. TRACY LEA GRAMER OTR/L, CHT

Table of content: MRS. TRACY LEA GRAMER OTR/L, CHT (NPI 1144340688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144340688 NPI number — MRS. TRACY LEA GRAMER OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAMER
Provider First Name:
TRACY
Provider Middle Name:
LEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144340688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7320 216TH ST SW STE 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMONDS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98026-8006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-673-3900
Provider Business Mailing Address Fax Number:
425-673-3910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19031 33RD AVE W STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-4731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-741-0056
Provider Business Practice Location Address Fax Number:
425-741-0057
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  OT00004260 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OT00004260 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 338248 . This is a "WA LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2122748 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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