Provider Demographics
NPI:1821425810
Name:NOBLE, TRACEY LEE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LEE
Last Name:NOBLE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:LEE
Other - Last Name:ELLENBECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:11116 CLAYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-1547
Mailing Address - Country:US
Mailing Address - Phone:813-401-1830
Mailing Address - Fax:813-854-5965
Practice Address - Street 1:2851 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3314
Practice Address - Country:US
Practice Address - Phone:727-789-8605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA633224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant