Active NPI
Tracy Ann Egge, OTR/L
- Occupational Therapist
- Crystal Lake, IL
National Provider Identifier
1336735844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056005855
- Practice address
- 3223 Il Route 176
Crystal Lake, IL 60014-2145 - Phone
- (815) 459-3023
- NPI assigned
- Dec 18, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 Therapist | 225X00000X | 056005855 | IL | Primary |
Addresses
Primary practice location
3223 Il Route 176
Crystal Lake, IL 60014-2145
Mailing address
1442 Blue Heron Dr
Crystal Lake, IL 60014-1970
Phone (847) 331-4496
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 |
|---|---|---|---|
| 056005855 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608249600000",
"number": "1336735844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1442 BLUE HERON DR",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600141970",
"telephone_number": "847-331-4496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3223 IL ROUTE 176",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600142145",
"telephone_number": "815-459-3023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EGGE",
"first_name": "TRACY",
"middle_name": "ANN",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-18",
"last_updated": "2020-12-18",
"certification_date": "2020-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056005855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.