Provider Demographics
NPI:1790410702
Name:GRAY, GILLIANN
Entity Type:Individual
Prefix:
First Name:GILLIANN
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 1:100 KILMORY DR
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38066-3676
Mailing Address - Country:US
Mailing Address - Phone:901-486-6837
Mailing Address - Fax:
Practice Address - Street 1:THE FARMS AT BAILEY STATION
Practice Address - Street 2:3300 S HOUSTON LEVEE RD
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38107
Practice Address - Country:US
Practice Address - Phone:901-779-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist