Provider Demographics
NPI:1679901748
Name:NORRIS, JILL SUZANNE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUZANNE
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:SUZANNE
Other - Last Name:BREITMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:5502 INNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4204
Mailing Address - Country:US
Mailing Address - Phone:502-595-7408
Mailing Address - Fax:
Practice Address - Street 1:5502 INNWOOD DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-4204
Practice Address - Country:US
Practice Address - Phone:502-595-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4703225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology