Provider Demographics
NPI:1457847428
Name:NOEL, BRENDA (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:NOEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 GREFF CT
Mailing Address - Street 2:
Mailing Address - City:DENAIR
Mailing Address - State:CA
Mailing Address - Zip Code:95316-9570
Mailing Address - Country:US
Mailing Address - Phone:209-604-7527
Mailing Address - Fax:
Practice Address - Street 1:2839 GREFF CT
Practice Address - Street 2:
Practice Address - City:DENAIR
Practice Address - State:CA
Practice Address - Zip Code:95316-9570
Practice Address - Country:US
Practice Address - Phone:209-604-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA973224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant