Provider Demographics
NPI:1932416815
Name:NOBLES, MICHELLE ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANN
Last Name:NOBLES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7608 E 91ST ST
Mailing Address - Street 2:TULSA
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6014
Mailing Address - Country:US
Mailing Address - Phone:918-663-0606
Mailing Address - Fax:918-663-8754
Practice Address - Street 1:503 PEPPERMINT DR
Practice Address - Street 2:SAND SPRINGS
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-2044
Practice Address - Country:US
Practice Address - Phone:952-270-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103903225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103903OtherSTATE OF MN DEPARTMENT OF HEALTH OCCUPATIONAL THERAPY PRACTITIONER LICENSE
MD276567OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC.