MEDICARE: WILHELMINA GRAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	311532	TX

General Provider Information

NPI Number	:	1265983373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILHELMINA GRAY

Provider Business Mailing Address
First Line	:	4606 ABIDIE GARDENS DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4346
Country	:	US
Telephone Number	:	713-391-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	4606 ABIDIE GARDENS DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4346
Country	:	US
Telephone Number	:	713-391-4651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	08/04/2023

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Directions to “ WILHELMINA GRAY ” Practice Location

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