MRS. TRACIE RENEE GRAHAM O.T. NPI 1265550875

NPI Information

NPI: 1265550875
Provider Name: MRS. TRACIE RENEE GRAHAM, O.T.
Classification: Specialist - 174400000X
Entity Type: Individual
Address:
413 W. TYLER COVE
WEST MEMPHIS, AR
ZIP 72301
Phone: (870) 733-1200
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MRS. Tracie Renee Graham, O.T. is a specialist in West Memphis, AR. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. MRS. Tracie Renee Graham, O.T. NPI is 1265550875. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

413 W. TYLER COVE
WEST MEMPHIS, AR
ZIP 72301
Phone: (870) 733-1200
Fax: (870) 732-3269

The enumeration date for this NPI number is 3/26/2007 and was last updated on 7/9/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		OTR1280	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5U518	OTHER	ARKANSAS	AR BLUECROSS BLUESHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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