Provider Demographics
NPI:1306034673
Name:BRAY, LEZLIE JO
Entity Type:Individual
Prefix:
First Name:LEZLIE
Middle Name:JO
Last Name:BRAY
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 1:1061 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-1839
Mailing Address - Country:US
Mailing Address - Phone:614-622-3242
Mailing Address - Fax:
Practice Address - Street 1:1061 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-1839
Practice Address - Country:US
Practice Address - Phone:614-622-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications