Healthcare Provider Details

I. General information

NPI: 1285352336
Provider Name (Legal Business Name): EMMA NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 HIGH ST
WORTHINGTON OH
43085-4057
US

IV. Provider business mailing address

809 CANDLEWOOD BLVD
PIQUA OH
45356-2713
US

V. Phone/Fax

Practice location:
  • Phone: 714-784-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberOT010645
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: