Healthcare Provider Details

I. General information

NPI: 1518525427
Provider Name (Legal Business Name): CLAIR-MARIE CARMEN GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5877 LIVERNOIS RD STE 101
TROY MI
48098-3100
US

IV. Provider business mailing address

910 FORESTDALE RD
ROYAL OAK MI
48067-1646
US

V. Phone/Fax

Practice location:
  • Phone: 248-828-3800
  • Fax:
Mailing address:
  • Phone: 248-318-6898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014076
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: