Provider Demographics
NPI:1376128082
Name:NOBILE, SASHA
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:NOBILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-3325
Mailing Address - Country:US
Mailing Address - Phone:401-864-5974
Mailing Address - Fax:
Practice Address - Street 1:8 COLONIAL DR # 1407
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1407
Practice Address - Country:US
Practice Address - Phone:508-366-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
RIOTA01195224Z00000X
MA4625224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant