Provider Demographics
NPI:1386771889
Name:GRAY, RONNA R (OT)
Entity type:Individual
Prefix:MS
First Name:RONNA
Middle Name:R
Last Name:GRAY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 TASMANIA DR
Mailing Address - Street 2:
Mailing Address - City:FREE UNION
Mailing Address - State:VA
Mailing Address - Zip Code:22940-1939
Mailing Address - Country:US
Mailing Address - Phone:434-973-3835
Mailing Address - Fax:434-979-8536
Practice Address - Street 1:1102 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5128
Practice Address - Country:US
Practice Address - Phone:434-979-8628
Practice Address - Fax:434-979-8536
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001252225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA189369OtherSOUTHERN HEALTH PROVIDER
VA7882549OtherAETNA PROVIDER NUMBER