Individual
MISTY GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
10588 ESTES RD, MACON, GA 31210-5145
(706) 975-9244
Mailing address
10588 ESTES RD, MACON, GA 31210-5145
(706) 975-9244
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT003589
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000954665C
—
GA
Enumeration date
03/27/2007
Last updated
10/09/2013
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