Healthcare Provider Details

I. General information

NPI: 1871895946
Provider Name (Legal Business Name): LAURA BRAY MS., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 LEWIS HARGETT CIR STE 120
LEXINGTON KY
40503
US

IV. Provider business mailing address

401 LEWIS HARGETT CIR STE 120
LEXINGTON KY
40503-3564
US

V. Phone/Fax

Practice location:
  • Phone: 859-457-4305
  • Fax:
Mailing address:
  • Phone: 859-475-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR3669
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number113861
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: