Provider Demographics
NPI:1245077254
Name:GHRAM, NOELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:GHRAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BENT TREE CT
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9251
Mailing Address - Country:US
Mailing Address - Phone:417-529-5955
Mailing Address - Fax:
Practice Address - Street 1:10346 E STONEGATE LN
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2053
Practice Address - Country:US
Practice Address - Phone:316-910-0024
Practice Address - Fax:316-910-0023
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01964225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist