MEDICARE: AMANDA DEE WARREN NEWTON DT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist		AR

General Provider Information

NPI Number	:	1316802127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA DEE WARREN NEWTON DT

Provider Business Mailing Address
First Line	:	4615 COLUMBIA ROAD 78
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-8916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4615 COLUMBIA ROAD 78
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-8916
Country	:	US
Telephone Number	:	870-904-1573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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