Provider Demographics
NPI:1447339007
Name:ROYAL, TRACI PETERS (OTR)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:PETERS
Last Name:ROYAL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8719 SAGEBRUSH LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5836
Mailing Address - Country:US
Mailing Address - Phone:210-826-9929
Mailing Address - Fax:210-340-6437
Practice Address - Street 1:85 NE LOOP 410
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5829
Practice Address - Country:US
Practice Address - Phone:210-340-2627
Practice Address - Fax:210-340-6437
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109144225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1334OtherBLUE CROSS BLUE SHEILD