Provider Demographics
NPI:1275778102
Name:NOBLE, MICHAEL GERARD (COTA MLD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GERARD
Last Name:NOBLE
Suffix:
Gender:M
Credentials:COTA MLD
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:GERARD
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA MLD
Mailing Address - Street 1:4013 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3919
Mailing Address - Country:US
Mailing Address - Phone:810-385-3026
Mailing Address - Fax:810-385-3026
Practice Address - Street 1:4013 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3919
Practice Address - Country:US
Practice Address - Phone:810-385-3026
Practice Address - Fax:810-385-3026
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1358322224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant