MEDICARE: CHRISTINE 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		CO

General Provider Information

NPI Number	:	1528577038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE GRAY

Provider Business Mailing Address
First Line	:	8783 BAMBOO GRV
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80951-4773
Country	:	US
Telephone Number	:	719-354-6306
Fax Number	:

Provider Business Practice Location Address
First Line	:	17659 WATER FLUME WAY
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7443
Country	:	US
Telephone Number	:	719-354-6306
Fax Number	:

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

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	06/07/2019

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Directions to “ CHRISTINE GRAY ” Practice Location

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