Provider Demographics
NPI:1124232020
Name:GRAY, BRADLEY JOHN (MOTRL, CHT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:JOHN
Last Name:GRAY
Suffix:
Gender:M
Credentials:MOTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 216TH ST SW STE 320
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8006
Mailing Address - Country:US
Mailing Address - Phone:425-673-3916
Mailing Address - Fax:425-673-3926
Practice Address - Street 1:7320 216TH ST SW STE 320
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8006
Practice Address - Country:US
Practice Address - Phone:425-673-3916
Practice Address - Fax:425-673-3926
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60020246225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2033397Medicaid
WA332019OtherWA LABOR & INDUSTRIES