Provider Demographics
NPI:1295994457
Name:DOWNEY, TRACIE LEANNE (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:LEANNE
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 BRIMWOOD STREET
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719
Mailing Address - Country:US
Mailing Address - Phone:870-307-1480
Mailing Address - Fax:
Practice Address - Street 1:675 BRIMWOOD STREET
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719
Practice Address - Country:US
Practice Address - Phone:870-307-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2135225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist