Provider Demographics
NPI:1487058236
Name:GRAY-ADONIS, SHARLEAN V (COTA)
Entity type:Individual
Prefix:MS
First Name:SHARLEAN
Middle Name:V
Last Name:GRAY-ADONIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:SHARLEAN
Other - Middle Name:
Other - Last Name:ADONIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:89 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1245
Mailing Address - Country:US
Mailing Address - Phone:862-763-1195
Mailing Address - Fax:
Practice Address - Street 1:77 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7330
Practice Address - Country:US
Practice Address - Phone:973-540-9800
Practice Address - Fax:197-373-4412
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09103400224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant