Provider Demographics
NPI:1881877348
Name:GRAY, EDWARD (OTR/L)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GRAY
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 1:12040 S JOG RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-4164
Mailing Address - Country:US
Mailing Address - Phone:561-733-5083
Mailing Address - Fax:
Practice Address - Street 1:12040 S JOG RD
Practice Address - Street 2:SUITE 8
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4164
Practice Address - Country:US
Practice Address - Phone:561-733-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9734225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist