Provider Demographics
NPI:1427015148
Name:FENSKE, NOELLE CHRISTI (MS, PT, CMPT)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:CHRISTI
Last Name:FENSKE
Suffix:
Gender:F
Credentials:MS, PT, CMPT
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:CHRISTI
Other - Last Name:SCHNEIDER P.T.
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PT
Mailing Address - Street 1:16200 19 MILE BOX 380713
Mailing Address - Street 2:MACOMB OAKLAND REGIONAL CNT.
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-416-2065
Mailing Address - Fax:586-228-7159
Practice Address - Street 1:16200 19 MILE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-416-2065
Practice Address - Fax:586-228-7159
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650Z910730OtherBLUE CROSS BLUE SHIELD
MI4472592Medicaid
MIP14030001Medicare ID - Type Unspecified