Healthcare Provider Details

I. General information

NPI: 1528990801
Provider Name (Legal Business Name): MIRIAM GRACE ELLIOTT COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 BOILING SPRINGS RD
GREER SC
29650-4139
US

IV. Provider business mailing address

409 RIELLO DR
GREER SC
29650-0955
US

V. Phone/Fax

Practice location:
  • Phone: 864-458-7566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5861
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: