Active NPI
Tracy Ralicki, OTR
- Gerontology Occupational Therapist
- South Haven, MI
National Provider Identifier
1659877512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Occupational Therapist
- License
- 5201000385
- Practice address
- 120 Baseline Rd
South Haven, MI 49090-1037 - Phone
- (269) 637-8411
- NPI assigned
- Mar 31, 2018
- Last updated
- Mar 31, 2018
- 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 |
|---|---|---|---|---|
| Gerontology Occupational Therapist | 225XG0600X | 5201000385 | MI | Primary |
Addresses
Primary practice location
120 Baseline Rd
South Haven, MI 49090-1037
Mailing address
120 Baseline Rd
South Haven, MI 49090-1037
Phone (269) 637-8411
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 |
|---|---|---|---|
| 5201000385 | MI | MD | Gerontology Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522454400000",
"number": "1659877512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 BASELINE RD",
"city": "SOUTH HAVEN",
"state": "MI",
"postal_code": "490901037",
"telephone_number": "269-637-8411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 BASELINE RD",
"city": "SOUTH HAVEN",
"state": "MI",
"postal_code": "490901037",
"telephone_number": "269-637-8411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RALICKI",
"first_name": "TRACY",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-31",
"last_updated": "2018-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "225XG0600X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Gerontology",
"state": "MI",
"license": "5201000385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Haven, MI
- PPSH Chiropractic Clinics, PLLC
- Jill Priebe
- Brian Scott Pullen, PHARMD
- Kashif Qamer, RPH
- Robert Edward Quinlan Jr., D.O.
- Randall Scott Davis (Shoreline Pharmacy)
- Elizabeth A Rasmussen, MSW
- Renal Care Group Southwest Michigan, LLC (RCG South Haven)
- Ripple Effects Autism Learning Center, LLC
- River Ridge Retirement Village
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.