Provider Demographics
NPI:1215256714
Name:GRAY, PRISCILLA R (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:PRISCILLA
Middle Name:R
Last Name:GRAY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
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Mailing Address - Street 1:2055 FAIRWAYS CT NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2093
Mailing Address - Country:US
Mailing Address - Phone:404-903-2845
Mailing Address - Fax:770-420-3341
Practice Address - Street 1:26 TOWER RD NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6947
Practice Address - Country:US
Practice Address - Phone:770-422-8913
Practice Address - Fax:770-420-3341
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000054OTA225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology