Provider Demographics
NPI:1932407426
Name:GRAY, MICHELLE ANNE (MS, OTR/L, CLT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS, OTR/L, CLT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:IOVANNISCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1608 GUNBARREL RD
Practice Address - Street 2:STE 103
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7197
Practice Address - Country:US
Practice Address - Phone:423-892-8070
Practice Address - Fax:423-893-9891
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5378225XH1200X
CAOT 12872225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand