Provider Demographics
NPI:1851023048
Name:MOBILE NOBLE OT
Entity Type:Organization
Organization Name:MOBILE NOBLE OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:310-927-2526
Mailing Address - Street 1:1661 BARCLAY AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-9212
Mailing Address - Country:US
Mailing Address - Phone:310-927-2526
Mailing Address - Fax:
Practice Address - Street 1:1661 BARCLAY AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9212
Practice Address - Country:US
Practice Address - Phone:310-927-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency