Provider Demographics
NPI:1528414406
Name:GRAY, KIONNA
Entity Type:Individual
Prefix:
First Name:KIONNA
Middle Name:
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 1:2262 ROCKSPRING RD
Mailing Address - Street 2:APT 26
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1680
Mailing Address - Country:US
Mailing Address - Phone:419-699-1324
Mailing Address - Fax:
Practice Address - Street 1:2262 ROCKSPRING RD
Practice Address - Street 2:APT 26
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1680
Practice Address - Country:US
Practice Address - Phone:419-699-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1358471744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management