Provider Demographics
NPI:1447471800
Name:OURS, NOELLE M
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:M
Last Name:OURS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1422
Mailing Address - Country:US
Mailing Address - Phone:814-598-7909
Mailing Address - Fax:
Practice Address - Street 1:500 ELM ST
Practice Address - Street 2:
Practice Address - City:PORTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14770-9793
Practice Address - Country:US
Practice Address - Phone:716-933-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008129235Z00000X
NY017761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist