Provider Demographics
NPI:1568822567
Name:COBLE, MARIAH (OTR)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:COBLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 FOXPOINTE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3278
Mailing Address - Country:US
Mailing Address - Phone:812-350-8996
Mailing Address - Fax:
Practice Address - Street 1:2625 FOX POINTE DR
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3278
Practice Address - Country:US
Practice Address - Phone:812-350-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006040A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist