Provider Demographics
NPI:1962521161
Name:RAY, CAROLYN
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MERIDIAN PARKE DR STE N PMB 159
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9424
Mailing Address - Country:US
Mailing Address - Phone:317-502-6366
Mailing Address - Fax:317-888-4680
Practice Address - Street 1:3100 MERIDIAN PARKE DR STE N PMB 159
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-9424
Practice Address - Country:US
Practice Address - Phone:317-502-6366
Practice Address - Fax:317-888-4680
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000664A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200720700 AOtherFIRST STEP PROVIDER #
IN200720700 AOtherPROVIDER NUMBER FOR FIRST