Provider Demographics
NPI:1558402925
Name:NOSSE, NOEL NICHOLAS (OTRL)
Entity type:Individual
Prefix:MR
First Name:NOEL
Middle Name:NICHOLAS
Last Name:NOSSE
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 SPARROW BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5488
Mailing Address - Country:US
Mailing Address - Phone:904-525-0635
Mailing Address - Fax:904-287-2492
Practice Address - Street 1:470 SPARROW BRANCH CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-5488
Practice Address - Country:US
Practice Address - Phone:904-525-0635
Practice Address - Fax:904-287-2492
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist