Provider Demographics
NPI:1083749857
Name:CRAY, WILLIAM KELLY (ATC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KELLY
Last Name:CRAY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SOUTH MIDDLEBROOK RD.
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-0000
Mailing Address - Country:US
Mailing Address - Phone:802-877-2329
Mailing Address - Fax:
Practice Address - Street 1:MEMORIAL FIELDHOUSE
Practice Address - Street 2:MIDDLEBURY COLLEGE
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-0000
Practice Address - Country:US
Practice Address - Phone:802-443-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00000032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer