Active NPI
Tracy Lynn Stanley, COTA
- Occupational Therapy Assistant
- Herrin, IL
National Provider Identifier
1124276381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 057002839
- Practice address
- 1901 N. 13TH Street
Herrin, IL 62948 - Phone
- (618) 942-3274
- Fax
- (618) 942-8240
- NPI assigned
- Aug 29, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057002839 | IL | Primary |
Addresses
Primary practice location
1901 N. 13TH Street
Herrin, IL 62948
Mailing address
1901 N. 13TH Street
Herrin, IL 62948
Phone (618) 942-3274
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057002839 | IL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219968000000",
"number": "1124276381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 N. 13TH STREET",
"city": "HERRIN",
"state": "IL",
"postal_code": "62948",
"telephone_number": "618-942-3274",
"fax_number": "618-942-8240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 N. 13TH STREET",
"city": "HERRIN",
"state": "IL",
"postal_code": "62948",
"telephone_number": "618-942-3274",
"fax_number": "618-942-8240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANLEY",
"first_name": "TRACY",
"middle_name": "LYNN",
"name_prefix": "Miss",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-29",
"last_updated": "2008-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "IL",
"license": "057002839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Herrin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.