=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528374659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMARA SUZANN NORRIS OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2010
-----------------------------------------------------
Last Update Date | 09/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 5TH ST
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66771-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-778-2784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 614 5TH ST
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66771-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-778-2784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 17-02225
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------