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General NPI Number Information
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NPI Number | 1104940980
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Entity Type | Individual
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Provider Name | MARY E WRAY LMT, NMT
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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 | 21 OLD KINGS RD N STE 215
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City | PALM COAST
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State | FL
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Zip | 32137-8254
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Country | US
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Telephone | 386-212-6068
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 352752
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City | PALM COAST
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State | FL
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Zip | 32135-2752
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Country | US
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Telephone | 386-212-6068
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | MA27453
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License Number State | FL
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