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NPI Code Detail

MEDICARE: CONNIE GRAY RBT

MEDICARE: CONNIE GRAY RBT
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
1106S00000XBehavior TechnicianRBT-20-138996IN

General Provider Information

NPI Number : 1679174460
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNIE GRAY RBT
Provider Business Mailing Address
First Line : 25360 NE ALBERTSON RD
Second Line :
City : HILLSBORO
State : OR
Zip : 97123
Country : US
Telephone Number : 503-799-2306
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 3771 S A ST
Second Line :
City : RICHMOND
State : IN
Zip : 47374-6053
Country : US
Telephone Number : 765-598-4197
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2020
Last Update Date : 06/11/2026

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Directions to “ CONNIE GRAY RBT” Practice Location

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