Provider Demographics
NPI:1386930501
Name:GRAY, TIFFANY (OTR)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6777 PERCY WAY
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1760
Mailing Address - Country:US
Mailing Address - Phone:470-778-8295
Mailing Address - Fax:
Practice Address - Street 1:6777 PERCY WAY
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-1760
Practice Address - Country:US
Practice Address - Phone:470-778-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63016743225X00000X
GAOT006705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist