Provider Demographics
NPI:1912943226
Name:GRAY, HEATHER BLISS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BLISS
Last Name:GRAY
Suffix:
Gender:F
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 1:136 SANDHILL CRANE RUN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8432
Mailing Address - Country:US
Mailing Address - Phone:407-797-7727
Mailing Address - Fax:321-281-4942
Practice Address - Street 1:1525 S ALAFAYA TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8926
Practice Address - Country:US
Practice Address - Phone:407-277-5400
Practice Address - Fax:321-281-4942
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11121225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888991100Medicaid