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General NPI Number Information
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NPI Number | 1578679379
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Entity Type | Individual
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Provider Name | KELLY SUE JEFFERS-GRAY MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 400 OVESEN DR
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City | WILTON
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State | IA
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Zip | 52778-9612
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Country | US
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Telephone | 563-732-4317
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Fax | 563-732-4318
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Provider Business Mailing Address
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Address Line | 850 43RD AVE STE 100
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City | MOLINE
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State | IL
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Zip | 61265-8401
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Country | US
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Telephone | 309-743-2070
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Fax | 309-743-2073
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 01527
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 01527
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License Number State | IA
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