MEDICARE: CASEY MARIE NORRIS

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1174186498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY MARIE NORRIS

Provider Business Mailing Address
First Line	:	1100 TURNER DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-1916
Country	:	US
Telephone Number	:	480-369-6367
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 TURNER DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-1916
Country	:	US
Telephone Number	:	480-369-6367
Fax Number	:

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

Provider Enumeration Date	:	04/22/2019
Last Update Date	:	04/22/2019

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