Provider Demographics
NPI:1649918327
Name:RAY, CALEB JUSTIN (OTR/L)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:JUSTIN
Last Name:RAY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4720
Mailing Address - Country:US
Mailing Address - Phone:770-459-6533
Mailing Address - Fax:770-462-1260
Practice Address - Street 1:2001 CHURCH LN
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-4720
Practice Address - Country:US
Practice Address - Phone:770-459-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist