Provider Demographics
NPI:1992157267
Name:NOBLES, ZACHARY (OTR/L)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
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 1:425 FRONT ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1639
Mailing Address - Country:US
Mailing Address - Phone:585-245-4729
Mailing Address - Fax:
Practice Address - Street 1:174 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1049
Practice Address - Country:US
Practice Address - Phone:607-729-0044
Practice Address - Fax:607-729-9994
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020675-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist