Provider Demographics
NPI:1548523368
Name:ELLIOTT, PAISLEY POLK (OT)
Entity type:Individual
Prefix:
First Name:PAISLEY
Middle Name:POLK
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:PAISLEY
Other - Middle Name:
Other - Last Name:POLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:8811 WARREN H ABERNATHY HWY
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1228
Mailing Address - Country:US
Mailing Address - Phone:864-574-7282
Mailing Address - Fax:864-574-7664
Practice Address - Street 1:8811 WARREN H ABERNATHY HWY
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1228
Practice Address - Country:US
Practice Address - Phone:864-574-7282
Practice Address - Fax:864-574-7664
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3578OtherSC LICENSE