Provider Demographics
NPI:1164492716
Name:NORMAN, LANCE MICHAEL (MOT, OTR/L, CHT)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:MICHAEL
Last Name:NORMAN
Suffix:
Gender:M
Credentials:MOT, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1601
Mailing Address - Country:US
Mailing Address - Phone:218-281-9377
Mailing Address - Fax:218-281-9336
Practice Address - Street 1:323 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1601
Practice Address - Country:US
Practice Address - Phone:218-281-9377
Practice Address - Fax:218-281-9336
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND423225X00000X
ND978472225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND24559OtherND BCBS
24781OtherDEMERS LOCATION
2605852OtherUNITED HEALTH CARE
340M9NOOtherBCBS MN
MN747655800OtherMEDICAL ASSISTANCE
ND24781OtherND BCBS
1042277OtherPREFERRED ONE
MN221978600OtherMEDICAL ASSISTANCE
ND54902Medicaid
6405687OtherDEMERS LOCATION
24559OtherNORIDIAN MUTUAL
HP62196OtherHEALTH PARTNERS
64-05686OtherMEDICA
ND24559OtherND BCBS
ND54902Medicaid
1042277OtherPREFERRED ONE
2605852OtherUNITED HEALTH CARE