Provider Demographics
NPI:1609266519
Name:BOBIS, NICHOLAS J (MS, OTR/L, ATC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:BOBIS
Suffix:
Gender:M
Credentials:MS, OTR/L, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-446-5417
Mailing Address - Fax:765-446-5317
Practice Address - Street 1:3806 AMELIA AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5772
Practice Address - Country:US
Practice Address - Phone:765-807-2773
Practice Address - Fax:765-807-2774
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006556A225X00000X, 225X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program