Provider Demographics
NPI:1669982955
Name:FAUBLE, CEARA JANE (OTR)
Entity type:Individual
Prefix:
First Name:CEARA
Middle Name:JANE
Last Name:FAUBLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 S 1 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:HARRIETTA
Mailing Address - State:MI
Mailing Address - Zip Code:49638-9407
Mailing Address - Country:US
Mailing Address - Phone:231-920-0525
Mailing Address - Fax:
Practice Address - Street 1:6678 COUNTY ROAD 32
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3554
Practice Address - Country:US
Practice Address - Phone:607-335-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009891225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist