Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 0000448 | CO |
NPI | 1003288689 |
---|---|
Provider Name | Ms. Donna P Gray |
First Address | Castle Rock, CO 80109-7950 |
Second Address | Wilsonville, OR 97070-9697 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2015 |
Last Update Date | 22/10/2015 |