Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 05971 | MD |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 05971 | MD |
NPI | 1851574982 |
---|---|
Provider Name | Leslie Ellen Gray |
First Address | Frederick, MD 21702-4503 |
Second Address | Frederick, MD 21702-8214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2007 |
Last Update Date | 31/10/2018 |