Healthcare Provider Details

I. General information

NPI: 1669336103
Provider Name (Legal Business Name): TESSA RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4206 ST. RT. 217
WILLOW WOOD OH
45696
US

IV. Provider business mailing address

4206 ST. RT. 217
WILLOW WOOD OH
45696
US

V. Phone/Fax

Practice location:
  • Phone: 740-612-9115
  • Fax:
Mailing address:
  • Phone: 740-612-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: