Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1013672476 |
---|---|
Provider Name | Kelsey Gray |
First Address | Knightstown, IN 46148-9682 |
Second Address | Rushville, IN 46173-1368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2021 |
Last Update Date | 01/11/2021 |