Healthcare Provider Details

I. General information

NPI: 1013838952
Provider Name (Legal Business Name): GRACE ELISABETH MORGAN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8133 ARDREY KELL RD STE 104
CHARLOTTE NC
28277-5723
US

IV. Provider business mailing address

331 E PARK RD APT 218
INDIAN TRAIL NC
28079-7877
US

V. Phone/Fax

Practice location:
  • Phone: 704-413-0968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number18650
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: