Healthcare Provider Details

I. General information

NPI: 1912943226
Provider Name (Legal Business Name): HEATHER BLISS GRAY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 S ALAFAYA TRL SUITE 102
ORLANDO FL
32828-8926
US

IV. Provider business mailing address

136 SANDHILL CRANE RUN
ORLANDO FL
32828-8432
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-5400
  • Fax: 321-281-4942
Mailing address:
  • Phone: 407-797-7727
  • Fax: 321-281-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT11121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: