Provider Demographics
NPI:1902187537
Name:FLEMMING-TRACY, TRACY R (OT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:R
Last Name:FLEMMING-TRACY
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 1:3105 INDEPENDENCE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4111
Mailing Address - Country:US
Mailing Address - Phone:205-803-2210
Mailing Address - Fax:205-803-2214
Practice Address - Street 1:3105 INDEPENDENCE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-4111
Practice Address - Country:US
Practice Address - Phone:205-803-2210
Practice Address - Fax:205-803-2214
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2469225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-22828OtherBLUE CROSS BLUE SHIELD ALABAMA
AL102I670028Medicare PIN