Healthcare Provider Details

I. General information

NPI: 1386771889
Provider Name (Legal Business Name): RONNA R GRAY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 ROSE HILL DR
CHARLOTTESVILLE VA
22903-5128
US

IV. Provider business mailing address

2015 TASMANIA DR
FREE UNION VA
22940-1939
US

V. Phone/Fax

Practice location:
  • Phone: 434-979-8628
  • Fax: 434-979-8536
Mailing address:
  • Phone: 434-973-3835
  • Fax: 434-979-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119001252
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: