Provider Demographics
NPI:1558561423
Name:NORVELL, SHELLY ANN (OTR)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANN
Last Name:NORVELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 MARTIN WAY E STE C
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5071
Mailing Address - Country:US
Mailing Address - Phone:360-923-5840
Mailing Address - Fax:
Practice Address - Street 1:3435 MARTIN WAY E STE C
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5071
Practice Address - Country:US
Practice Address - Phone:360-923-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002553225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341349Medicaid
WA8341349Medicaid