Provider Demographics
NPI:1235398900
Name:NORRIE, SHAUNA R (MOT OTR/L)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:R
Last Name:NORRIE
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1738
Mailing Address - Country:US
Mailing Address - Phone:716-250-6492
Mailing Address - Fax:716-250-4178
Practice Address - Street 1:310 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4515
Practice Address - Country:US
Practice Address - Phone:701-530-8800
Practice Address - Fax:701-751-4550
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1473375Medicaid
1235398900OtherPREFERRED ONE
ND1235398900OtherBC/BS
ND55266Medicaid
MN1235398900OtherBC/BS