Provider Demographics
NPI:1033710686
Name:GRAY, TAMMY JEANINE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEANINE
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7878 E FACTORY RD
Mailing Address - Street 2:
Mailing Address - City:WEST ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:45381-9509
Mailing Address - Country:US
Mailing Address - Phone:937-529-1438
Mailing Address - Fax:
Practice Address - Street 1:7878 E FACTORY RD
Practice Address - Street 2:
Practice Address - City:WEST ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:45381-9509
Practice Address - Country:US
Practice Address - Phone:937-529-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care