Individual
MARY JO RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
318 WEST PIKE STREET, SUITE 104, LAWRENCEVILLE, GA 30045
(678) 377-2833
Mailing address
2620 N. BERKELY LAKE RD., NW #1032, DULUTH, GA 30096
(404) 375-2577
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT004020
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340274
WELLCARE- AAKTS
GA
Enumeration date
11/27/2006
Last updated
07/09/2007
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