MEDICARE: DEVA NORVELL OTRL

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	131866	KY

General Provider Information

NPI Number	:	1477097525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVA NORVELL OTRL

Provider Business Mailing Address
First Line	:	1075 E 4TH ST
Second Line	:	SUITE 2
City	:	LONDON
State	:	KY
Zip	:	40741-2528
Country	:	US
Telephone Number	:	606-682-9579
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 E 4TH ST
Second Line	:	SUITE 2
City	:	LONDON
State	:	KY
Zip	:	40741-2528
Country	:	US
Telephone Number	:	606-682-9579
Fax Number	:

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

Provider Enumeration Date	:	12/08/2016
Last Update Date	:	12/08/2016

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Directions to “ DEVA NORVELL OTRL” Practice Location

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