Healthcare Provider Details

I. General information

NPI: 1457571929
Provider Name (Legal Business Name): EMILY TERESE NORRIS D.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 W LAFAYETTE ST
OTTAWA IL
61350-1761
US

IV. Provider business mailing address

1428 W LAFAYETTE ST
OTTAWA IL
61350-1761
US

V. Phone/Fax

Practice location:
  • Phone: 815-343-6824
  • Fax:
Mailing address:
  • Phone: 815-343-6824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberEZ65610802P
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: