Healthcare Provider Details

I. General information

NPI: 1003681511
Provider Name (Legal Business Name): MICHAEL CAUBLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6231 N MONTEBELLA RD
TUCSON AZ
85704-2892
US

IV. Provider business mailing address

9555 E VALLEY VERDE TRL
HEREFORD AZ
85615-8867
US

V. Phone/Fax

Practice location:
  • Phone: 520-500-8348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number123736
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-009382
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: