Provider Demographics
NPI:1851801765
Name:NOGLE, STEPHANIE JO (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:NOGLE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JO
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT/S
Mailing Address - Street 1:ANDERS GROUP: S. NOGLE C/O K. SCHRADER 105 DECKER CT.
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:940-727-9839
Mailing Address - Fax:
Practice Address - Street 1:BROOKS AMERICARE: 4251 NW AMERICAN LN
Practice Address - Street 2:#103
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055
Practice Address - Country:US
Practice Address - Phone:386-438-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist