Provider Demographics
NPI:1710646237
Name:GRAY, BRIANNA HOPE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:HOPE
Last Name:GRAY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LOOKOUT
Mailing Address - State:WV
Mailing Address - Zip Code:26678-9217
Mailing Address - Country:US
Mailing Address - Phone:304-610-3694
Mailing Address - Fax:
Practice Address - Street 1:414 HONEYSUCKLE LN
Practice Address - Street 2:
Practice Address - City:MOUNT LOOKOUT
Practice Address - State:WV
Practice Address - Zip Code:26678-9217
Practice Address - Country:US
Practice Address - Phone:304-610-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2203225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist