Provider Demographics
NPI:1750778015
Name:GOBLER, KELLY (COTA/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GOBLER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 NE QUINCE AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3809
Mailing Address - Country:US
Mailing Address - Phone:541-706-0393
Mailing Address - Fax:
Practice Address - Street 1:3000 SW 32ND STREET
Practice Address - Street 2:THE HEIGHTS ASSISTED LIVING
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-316-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1006820224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant