Traci Ann Soule, CTRS

Primary specialty

Recreation TherapistTaxonomy code 225800000X

License

85396 Issued in NY

Practice address

1032 Rainbow Ave
Portage, MI 49024-3483

Phone

(314) 369-2609

NPI assigned

Feb 23, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Traci Ann Tibbetts Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677110400000",
    "number": "1548969082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 RAINBOW AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490243483",
            "telephone_number": "314-369-2609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 RAINBOW AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490243483",
            "telephone_number": "314-369-2609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOULE",
        "first_name": "TRACI",
        "middle_name": "ANN",
        "credential": "CTRS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-23",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": "NY",
            "license": "85396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACI",
            "last_name": "TIBBETTS",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Recreation Therapist in Portage, MI
• Providers in Portage, MI by specialty
• Recreation Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.