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General NPI Number Information
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NPI Number | 1093839508
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Entity Type | Individual
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Provider Name | KATHLEEN A RAY
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5420 WAYNE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-3029
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Country | US
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Telephone | 317-442-1573
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Fax | 317-357-3625
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Provider Business Mailing Address
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Address Line | 5420 WAYNE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-3029
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 948032
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License Number State | IN
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