Provider Demographics
NPI:1841511292
Name:NOBLES, TIM L (OTR/L)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:L
Last Name:NOBLES
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 LAZY RIVER LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2385
Mailing Address - Country:US
Mailing Address - Phone:912-266-3356
Mailing Address - Fax:
Practice Address - Street 1:12200 CRABAPPLE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4020
Practice Address - Country:US
Practice Address - Phone:770-573-1715
Practice Address - Fax:770-573-0887
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00041225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist