Healthcare Provider Details

I. General information

NPI: 1639867740
Provider Name (Legal Business Name): TREESA GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 LOTUSHILL DR
CINCINNATI OH
45240-3313
US

IV. Provider business mailing address

1887 LOTUSHILL DR
CINCINNATI OH
45240-3313
US

V. Phone/Fax

Practice location:
  • Phone: 513-386-4242
  • Fax:
Mailing address:
  • Phone: 513-386-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: