Provider Demographics
NPI:1417661828
Name:DELISLE, NOAH JAMES (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:JAMES
Last Name:DELISLE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 SE RHONE ST APT SUITE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2966
Mailing Address - Country:US
Mailing Address - Phone:360-524-2986
Mailing Address - Fax:
Practice Address - Street 1:5510 SE RHONE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2966
Practice Address - Country:US
Practice Address - Phone:360-524-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR102022462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer