Provider Demographics
NPI:1023881109
Name:MCCARTY, GRAYSON PATE (OTR/L)
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:PATE
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-2043
Mailing Address - Country:US
Mailing Address - Phone:276-759-1433
Mailing Address - Fax:
Practice Address - Street 1:800 E MAIN ST STE 160
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-3322
Practice Address - Country:US
Practice Address - Phone:276-228-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119010179225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist