Provider Demographics
NPI:1396786471
Name:CLINE, NANCY NOELLE (OT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:NOELLE
Last Name:CLINE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:NOELLE
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43301-1827
Mailing Address - Country:US
Mailing Address - Phone:740-383-8055
Mailing Address - Fax:740-375-8159
Practice Address - Street 1:1050 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-383-8055
Practice Address - Fax:740-375-8159
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT002441225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
311704991OtherPHYSICIANS NON PHYSICIANS
OH000000351725OtherANTHEM
311704991OtherTAX ID E
311704991OtherTAX ID
000000351725OtherANTHEM
OH000000351725OtherANTHEM
311704991OtherPHYSICIANS NON PHYSICIANS
P00185570Medicare ID - Type UnspecifiedTRAVELERS