Healthcare Provider Details

I. General information

NPI: 1700798964
Provider Name (Legal Business Name): MOLLEE ALEXIS GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 S 3RD ST
DAYTON WA
99328-1606
US

IV. Provider business mailing address

222 E RICHMOND AVE
DAYTON WA
99328-1043
US

V. Phone/Fax

Practice location:
  • Phone: 509-382-2531
  • Fax:
Mailing address:
  • Phone: 509-844-5274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT70028140
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: