| Doctor Name: | MRS. TRACIE RENEE GRAHAM |
| NPI Number: | 1265550875 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | O.T. |
| License Number: | OTR1280 |
| Business Practice Address: | 413 W. Tyler Cove West Memphis, AR - 72301 |
| Business Phone Number: | 8707331200 |
| Business Fax Number: | 8707323269 |
| Mailing Address: | 4734 Bethay Dr, MEMPHIS |
| State: | TN |
| Postal Code: | 381255700 |
| Phone Number: | 9014943710 |
| Fax Number: | 8707331200 |
| NPI Enumeration Date: | 03/26/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | OTR1280 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |