Healthcare Provider Details

I. General information

NPI: 1649191529
Provider Name (Legal Business Name): REVEKAHLEI GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 W 260 N
OREM UT
84057-1970
US

IV. Provider business mailing address

5406 W CHRISTIE CT
HIGHLAND UT
84003-9171
US

V. Phone/Fax

Practice location:
  • Phone: 801-221-9930
  • Fax: 801-221-9930
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: