| Doctor Name: | TRACEY L AIRTH-EDBLOM |
| NPI Number: | 1053571307 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | OTR/L, CHT |
| License Number: | OT345 |
| Business Practice Address: | 226 Weller St Petaluma, CA - 949523136 |
| Business Phone Number: | 7077627678 |
| Business Fax Number: | 7077627679 |
| Mailing Address: | 8 Pacific Dr, NOVATO |
| State: | CA |
| Postal Code: | 949495479 |
| Phone Number: | 4153828202 |
| Fax Number: | 4153828212 |
| NPI Enumeration Date: | 06/11/2008 |
| NPI Last Update Date: | 06/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225XH1200X |
| License Number: | OT345 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Occupational Therapist |
| Taxonomy Specialization: | Hand |
| Taxonomy Definition: | |