Provider Demographics
NPI:1942824461
Name:GRAY, LAUREN TERESA (COTA)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:TERESA
Last Name:GRAY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 BAYER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4208
Mailing Address - Country:US
Mailing Address - Phone:260-580-6574
Mailing Address - Fax:
Practice Address - Street 1:7125 HANNA ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46816-1166
Practice Address - Country:US
Practice Address - Phone:260-447-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant