Individual
AMY MARIE GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 ROWLAND WAY STE 205, NOVATO, CA 94945-5041
(415) 492-4870
(415) 492-4871
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(415) 492-4870
(415) 492-4871
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2593
CA
225XP0200X
Pediatric Occupational Therapist
2593
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2593
STATE MEDICAL LICENSE
CA
Enumeration date
01/29/2019
Last updated
12/04/2020
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