Provider Demographics
NPI:1871726919
Name:BARRILLEAUX, TRACY JOHNSON (OTR)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:JOHNSON
Last Name:BARRILLEAUX
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 1:4242 OFFICE PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3629
Mailing Address - Country:US
Mailing Address - Phone:214-828-9900
Mailing Address - Fax:214-828-9901
Practice Address - Street 1:4242 OFFICE PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3629
Practice Address - Country:US
Practice Address - Phone:214-828-9900
Practice Address - Fax:214-828-9901
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist