Provider Demographics
NPI:1528640158
Name:DELANEY, MARY GRACE (COTA/L, CLT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:GRACE
Last Name:DELANEY
Suffix:
Gender:F
Credentials:COTA/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 TODD RD
Mailing Address - Street 2:
Mailing Address - City:HONEA PATH
Mailing Address - State:SC
Mailing Address - Zip Code:29654-9197
Mailing Address - Country:US
Mailing Address - Phone:864-634-6037
Mailing Address - Fax:
Practice Address - Street 1:420 THOMSON CIR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5656
Practice Address - Country:US
Practice Address - Phone:864-366-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3546224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant