Provider Demographics
NPI:1558779421
Name:RAY, NATALIE (MOT)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 HIGHWAY 51 N APT 9-107
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-7960
Mailing Address - Country:US
Mailing Address - Phone:901-258-6890
Mailing Address - Fax:
Practice Address - Street 1:8397 ANSLEY PARK LN
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-8338
Practice Address - Country:US
Practice Address - Phone:901-258-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4448225X00000X
MSOT2780225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist