Healthcare Provider Details

I. General information

NPI: 1225993744
Provider Name (Legal Business Name): ABBY GRACE WOODARD COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 GREENVILLE BLVD SE
GREENVILLE NC
27858-5758
US

IV. Provider business mailing address

308 GREENVILLE BLVD SE
GREENVILLE NC
27858-5758
US

V. Phone/Fax

Practice location:
  • Phone: 704-654-8599
  • Fax: 980-938-6088
Mailing address:
  • Phone: 704-654-8599
  • Fax: 980-938-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number16631
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: