Provider Demographics
NPI:1104083625
Name:GRAY, DEBRA LEE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEE
Last Name:GRAY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 BOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03603-4427
Mailing Address - Country:US
Mailing Address - Phone:603-826-3128
Mailing Address - Fax:
Practice Address - Street 1:1094 BOROUGH RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:NH
Practice Address - Zip Code:03603-4427
Practice Address - Country:US
Practice Address - Phone:603-826-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT073-0000177224Z00000X
NH0556224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant