Healthcare Provider Details

I. General information

NPI: 1891607602
Provider Name (Legal Business Name): KATHLEEN GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W PUTNAM AVE
GREENWICH CT
06830-6086
US

IV. Provider business mailing address

34 EASTHILL RD
STAMFORD CT
06903-3101
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-4290
  • Fax:
Mailing address:
  • Phone: 315-762-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number003988
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: