Provider Demographics
NPI:1487681516
Name:RAY, R RICHARD JR (EDD, ATC)
Entity type:Individual
Prefix:DR
First Name:R
Middle Name:RICHARD
Last Name:RAY
Suffix:JR
Gender:M
Credentials:EDD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 STANDISH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-5243
Mailing Address - Country:US
Mailing Address - Phone:616-396-8220
Mailing Address - Fax:
Practice Address - Street 1:222 FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3735
Practice Address - Country:US
Practice Address - Phone:616-395-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer