Individual provider Active NPI

Mary Jo Ray

  • Pediatric Occupational Therapist
  • Lawrenceville, GA
National Provider Identifier
1962578450
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
OT004020 Issued in GA
Practice address
318 West Pike Street
Suite 104
Lawrenceville, GA 30045
Phone
(678) 377-2833
NPI assigned
Nov 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X OT004020 GA Primary

Addresses

Primary practice location

318 West Pike Street
Suite 104
Lawrenceville, GA 30045

Mailing address

2620 N. Berkely Lake Rd.
NW #1032
Duluth, GA 30096
Phone (404) 375-2577

Other identifiers 1

IdentifierTypeStateIssuer
340274OtherGAWELLCARE- AAKTS

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

LicenseStateTypeSpecialty
OT004020GAMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
All About Kids Therapy Services, Inc. Pediatrics Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1962578450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 N. BERKELY LAKE RD.",
            "address_2": "NW #1032",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30096",
            "telephone_number": "404-375-2577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 WEST PIKE STREET",
            "address_2": "SUITE 104",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30045",
            "telephone_number": "678-377-2833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAY",
        "first_name": "MARY",
        "middle_name": "JO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT004020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE- AAKTS",
            "identifier": "340274",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.