Provider Demographics
NPI:1194038950
Name:NOBLITT, JILL (ATC, L)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:NOBLITT
Suffix:
Gender:F
Credentials:ATC, L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 GRABILL DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8011
Mailing Address - Country:US
Mailing Address - Phone:317-867-4547
Mailing Address - Fax:
Practice Address - Street 1:8227 NORTHWEST BLVD STE 160
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1386
Practice Address - Country:US
Practice Address - Phone:317-415-5747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000540A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer