Provider Demographics
NPI:1528322369
Name:CONNOR, NOELLE BRIANNA (OT)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:BRIANNA
Last Name:CONNOR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S BROADWAY STE 203
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6682
Mailing Address - Country:US
Mailing Address - Phone:805-922-1711
Mailing Address - Fax:805-361-0186
Practice Address - Street 1:150 S MARY AVE STE 1
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-7821
Practice Address - Country:US
Practice Address - Phone:805-929-3230
Practice Address - Fax:805-929-3232
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT12608225X00000X, 225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand