Provider Demographics
NPI:1851574982
Name:GRAY, LESLIE ELLEN (OCCUPATIONAL THERAPY)
Entity Type:Individual
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First Name:LESLIE
Middle Name:ELLEN
Last Name:GRAY
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Gender:F
Credentials:OCCUPATIONAL THERAPY
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Mailing Address - Street 1:187 THOMAS JOHNSON DR
Mailing Address - Street 2:6
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4503
Mailing Address - Country:US
Mailing Address - Phone:301-663-1157
Mailing Address - Fax:301-663-1229
Practice Address - Street 1:350 MONTEVUE LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-8214
Practice Address - Country:US
Practice Address - Phone:301-600-7413
Practice Address - Fax:301-600-3280
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2018-10-31
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Provider Licenses
StateLicense IDTaxonomies
MD05971225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation