Provider Demographics
NPI:1124255344
Name:GRAY, ELIZABETH J (OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:GRAY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:ASHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01330-0464
Mailing Address - Country:US
Mailing Address - Phone:856-472-9687
Mailing Address - Fax:
Practice Address - Street 1:16 WEST ST
Practice Address - Street 2:
Practice Address - City:WEST HATFIELD
Practice Address - State:MA
Practice Address - Zip Code:01088-9515
Practice Address - Country:US
Practice Address - Phone:413-247-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10185225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist