Provider Demographics
NPI:1750740585
Name:GRAY, SHELLEY
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BLALOCK RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6443
Mailing Address - Country:US
Mailing Address - Phone:713-468-0300
Mailing Address - Fax:713-468-0336
Practice Address - Street 1:1240 BLALOCK RD
Practice Address - Street 2:SUITE 170
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6443
Practice Address - Country:US
Practice Address - Phone:713-468-0300
Practice Address - Fax:713-468-0336
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117407225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist