Provider Demographics
NPI:1659870137
Name:NORRIS, NELLY (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:MC INTOSH
Mailing Address - State:FL
Mailing Address - Zip Code:32664-0500
Mailing Address - Country:US
Mailing Address - Phone:352-208-8401
Mailing Address - Fax:844-270-4798
Practice Address - Street 1:20400 10TH STREET UNIT 1
Practice Address - Street 2:
Practice Address - City:MCINTOSH
Practice Address - State:FL
Practice Address - Zip Code:32664-0500
Practice Address - Country:US
Practice Address - Phone:352-208-8401
Practice Address - Fax:844-270-4798
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-1317225X00000X
WAOT60824890225XH1200X
FLOT16073225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand