Provider Demographics
NPI:1083874473
Name:NORRIS, SHANNON T (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:T
Last Name:NORRIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:T
Other - Last Name:FALKENSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:25833 HIGHWAY 181
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-6101
Mailing Address - Country:US
Mailing Address - Phone:251-689-8153
Mailing Address - Fax:251-625-6515
Practice Address - Street 1:25833 HIGHWAY 181
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-6101
Practice Address - Country:US
Practice Address - Phone:251-689-8153
Practice Address - Fax:251-625-6515
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2113225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51546373OtherBLUE CROSS BLUE SHIELD AL