Provider Demographics
NPI:1447864897
Name:WILLIAMS, TRACY ANN (COTA)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:A
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1032 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-2409
Mailing Address - Country:US
Mailing Address - Phone:209-466-5341
Mailing Address - Fax:
Practice Address - Street 1:1032 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2409
Practice Address - Country:US
Practice Address - Phone:209-466-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA956224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant