Provider Demographics
NPI:1932788593
Name:GRAY, ERICA KAYLIN (COTA/L)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:KAYLIN
Last Name:GRAY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:KAYLIN
Other - Last Name:BEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:11849 MAJESTIC LN NW APT 103
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7934
Mailing Address - Country:US
Mailing Address - Phone:618-910-0549
Mailing Address - Fax:
Practice Address - Street 1:5455 CONVERSE AVE SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-7809
Practice Address - Country:US
Practice Address - Phone:360-874-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005553224Z00000X
WA61379515224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant