Provider Demographics
NPI:1033485503
Name:GRAY, BRENDA GAIL (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:GAIL
Last Name:GRAY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 INDIAN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-9515
Mailing Address - Country:US
Mailing Address - Phone:828-493-0602
Mailing Address - Fax:
Practice Address - Street 1:1497 INDIAN HILLS DR
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-9515
Practice Address - Country:US
Practice Address - Phone:828-493-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2368224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant