Provider Demographics
NPI:1043198542
Name:NOBLE, LILY KATHRYN (OTR/L)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:KATHRYN
Last Name:NOBLE
Suffix:
Gender:F
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 1:56880 VENTURE LANE STE N104 #216
Mailing Address - Street 2:
Mailing Address - City:SUNRIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97707
Mailing Address - Country:US
Mailing Address - Phone:603-236-9892
Mailing Address - Fax:
Practice Address - Street 1:520 NW WALL ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2608
Practice Address - Country:US
Practice Address - Phone:541-355-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR439002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist