Provider Demographics
NPI:1316123896
Name:COLLINS, TRACEY L (OT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MCKAY ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3032
Mailing Address - Country:US
Mailing Address - Phone:978-927-1499
Mailing Address - Fax:
Practice Address - Street 1:235 NEWBURY ST
Practice Address - Street 2:ROUTE 1 NORTHBOUND
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1001
Practice Address - Country:US
Practice Address - Phone:978-774-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5744225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist