Active NPI
Carolyn Gray, RSA
- Rehabilitation Practitioner
- Waterloo, IL
National Provider Identifier
1083377121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 988 N Illinois Route 3
Waterloo, IL 62298-1059 - Phone
- (618) 939-4444
- NPI assigned
- Oct 15, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | Primary |
Addresses
Primary practice location
988 N Illinois Route 3
Waterloo, IL 62298-1059
Mailing address
988 N Illinois Route 3
Waterloo, IL 62298-1059
Phone (618) 939-4444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634256000000",
"number": "1083377121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "988 N ILLINOIS ROUTE 3",
"city": "WATERLOO",
"state": "IL",
"postal_code": "622981059",
"telephone_number": "618-939-4444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "988 N ILLINOIS ROUTE 3",
"city": "WATERLOO",
"state": "IL",
"postal_code": "622981059",
"telephone_number": "618-939-4444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "CAROLYN",
"credential": "RSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-15",
"last_updated": "2021-10-15",
"certification_date": "2021-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.