Provider Demographics
NPI:1497367965
Name:TRACY, CHRISTIANA
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11681 VOYAGER PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3861
Mailing Address - Country:US
Mailing Address - Phone:719-344-9342
Mailing Address - Fax:
Practice Address - Street 1:5446 N ACADEMY BLVD STE 204
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3669
Practice Address - Country:US
Practice Address - Phone:719-598-5555
Practice Address - Fax:719-388-2030
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1220224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONAOtherNA