Provider Demographics
NPI:1770778854
Name:BRAY, JULIE BETH (OT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:BETH
Last Name:BRAY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 HIGHWAY ALT 2
Mailing Address - Street 2:
Mailing Address - City:SHONGALOO
Mailing Address - State:LA
Mailing Address - Zip Code:71072-2862
Mailing Address - Country:US
Mailing Address - Phone:318-624-8530
Mailing Address - Fax:318-624-8530
Practice Address - Street 1:206 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:LA
Practice Address - Zip Code:71075-3444
Practice Address - Country:US
Practice Address - Phone:318-539-4006
Practice Address - Fax:318-539-4008
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist