Provider Demographics
NPI:1437866811
Name:GRAY, SHAUNDE (MHA, COTA, LIA)
Entity Type:Individual
Prefix:
First Name:SHAUNDE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MHA, COTA, LIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 IRA RD
Mailing Address - Street 2:
Mailing Address - City:MOUND BAYOU
Mailing Address - State:MS
Mailing Address - Zip Code:38762-9708
Mailing Address - Country:US
Mailing Address - Phone:713-569-5269
Mailing Address - Fax:
Practice Address - Street 1:197 IRA RD
Practice Address - Street 2:
Practice Address - City:MOUND BAYOU
Practice Address - State:MS
Practice Address - Zip Code:38762-9708
Practice Address - Country:US
Practice Address - Phone:713-569-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217657225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics