Healthcare Provider Details

I. General information

NPI: 1952823908
Provider Name (Legal Business Name): MARIANNA NEWSAM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 W 80TH ST STE A
LOS ANGELES CA
90045-1166
US

IV. Provider business mailing address

6605 W 80TH ST STE A
LOS ANGELES CA
90045-1166
US

V. Phone/Fax

Practice location:
  • Phone: 424-218-6884
  • Fax:
Mailing address:
  • Phone: 424-218-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: