Active NPI
Trevor Ryan Ray, COTA/L
- Occupational Therapy Assistant
- Winter Haven, FL
National Provider Identifier
1093415333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 19228
- Practice address
- 400 North Lake Howard Drive
Winter Haven, FL 33881 - Phone
- (863) 875-3599
- NPI assigned
- Mar 6, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 19228 | FL | Primary |
Addresses
Primary practice location
400 North Lake Howard Drive
Winter Haven, FL 33881
Mailing address
470 Citi Ctr St # 1220
Winter Haven, FL 33880-3425
Phone (863) 662-2179
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19228 | FL | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719792000000",
"number": "1093415333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "470 CITI CTR ST # 1220",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338803425",
"telephone_number": "863-662-2179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 NORTH LAKE HOWARD DRIVE",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "33881",
"telephone_number": "863-875-3599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAY",
"first_name": "TREVOR",
"middle_name": "RYAN",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-06",
"last_updated": "2024-07-01",
"certification_date": "2024-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "19228",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Haven, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.