Active NPI
Cynthia Lou Gray, OTR
- Occupational Therapist
- Detroit Lakes, MN
National Provider Identifier
1215416896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 100913
- Practice address
- Essentia Health St. Mary'S Detroilakes
1027 Washington Avenue
Detroit Lakes, MN 56501-3409 - Phone
- (218) 847-3409
- NPI assigned
- Aug 14, 2018
- Sex
- Female
- 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 Therapist | 225X00000X | 100913 | MN | Primary |
Addresses
Primary practice location
Essentia Health St. Mary'S Detroilakes
1027 Washington Avenue
Detroit Lakes, MN 56501-3409
Mailing address
400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 847-5611
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 |
|---|---|---|---|
| 100913 | MN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552608000000",
"number": "1215416896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E 3RD ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558051951",
"telephone_number": "218-847-5611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ESSENTIA HEALTH ST. MARY'S DETROILAKES",
"address_2": "1027 WASHINGTON AVENUE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565013409",
"telephone_number": "218-847-3409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "CYNTHIA",
"middle_name": "LOU",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-14",
"last_updated": "2019-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "100913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.