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General NPI Number Information
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NPI Number | 1669342457
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Entity Type | Individual
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Provider Name | LISA WRAY
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Gender | Female
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 6200 AURORA AVE STE 500W-30
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City | URBANDALE
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State | IA
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Zip | 50322-2800
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Country | US
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Telephone | 515-868-4937
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Fax |
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Provider Business Mailing Address
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Address Line | 11590 NW 107TH CT
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City | GRANGER
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State | IA
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Zip | 50109-9701
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 00467
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License Number State | IA
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