MEDICARE: ALYSSA JEANNE NORENBERG OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT00003971	WA
2	225XP0200X	Pediatric Occupational Therapist	103458	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6943NO	OTHER	WA	BLUE SHIELD

General Provider Information

NPI Number	:	1962498881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA JEANNE NORENBERG OTR

Provider Business Mailing Address
First Line	:	5352 47TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-2314
Country	:	US
Telephone Number	:	651-592-8870
Fax Number	:

Provider Business Practice Location Address
First Line	:	8758 EGAN DR
Second Line	:
City	:	SAVAGE
State	:	MN
Zip	:	55378-2561
Country	:	US
Telephone Number	:	952-443-9888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	03/29/2017

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