Provider Demographics
NPI:1992213532
Name:GRAY, MEGAN ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ELIZABETH
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 1:1218 E GREENCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-7254
Mailing Address - Country:US
Mailing Address - Phone:317-460-7816
Mailing Address - Fax:
Practice Address - Street 1:1001 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1474
Practice Address - Country:US
Practice Address - Phone:317-745-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INNAOtherNA