Provider Demographics
NPI:1023633245
Name:CURTIS, TRACY LEE (RBT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 WALKER ST SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-5978
Mailing Address - Country:US
Mailing Address - Phone:407-508-6771
Mailing Address - Fax:
Practice Address - Street 1:1690 WALKER ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-5978
Practice Address - Country:US
Practice Address - Phone:407-508-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician