Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT008229 | GA |
NPI | 1003578915 |
---|---|
Provider Name | Taylor Elizabeth Gray |
First Address | Valdosta, GA 31602-2919 |
Second Address | Valdosta, GA 31602-2919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2021 |
Last Update Date | 07/10/2021 |