Individual
GRACE MARIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
29 N ACADEMY ST, GREENVILLE, SC 29601-2629
(864) 331-1350
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 797-6308
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5603
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2187155
—
OH
01
—
AB7360731
MEDICARE PIN
OH
Enumeration date
12/06/2017
Last updated
08/02/2019
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