Provider Demographics
NPI:1023146909
Name:WRAY, NEALIE (OTRL)
Entity type:Individual
Prefix:
First Name:NEALIE
Middle Name:
Last Name:WRAY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:MC CLURE
Mailing Address - State:PA
Mailing Address - Zip Code:17841-8818
Mailing Address - Country:US
Mailing Address - Phone:717-994-2043
Mailing Address - Fax:
Practice Address - Street 1:61 DUKE ST
Practice Address - Street 2:
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857-1908
Practice Address - Country:US
Practice Address - Phone:570-463-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT-009017L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist