Healthcare Provider Details

I. General information

NPI: 1710897582
Provider Name (Legal Business Name): MISTY LYNN GRAY MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY LYNN GRAY WALDSCHMIDT

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W 182ND ST
TORRANCE CA
90504-4837
US

IV. Provider business mailing address

1706 CAMINO DE LA COSTA APT C
REDONDO BEACH CA
90277-5408
US

V. Phone/Fax

Practice location:
  • Phone: 310-533-4513
  • Fax:
Mailing address:
  • Phone: 310-803-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: