Provider Demographics
NPI:1073162525
Name:CONLEY, NOELLE MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:MARIE
Last Name:CONLEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:MARIE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:6161 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3426
Mailing Address - Country:US
Mailing Address - Phone:989-790-3781
Mailing Address - Fax:
Practice Address - Street 1:6161 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3426
Practice Address - Country:US
Practice Address - Phone:989-790-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist