Healthcare Provider Details

I. General information

NPI: 1922210384
Provider Name (Legal Business Name): NANCY NEWTON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY TIBBETT OTR/L

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 CAPITOL AVE SUITE 106
SACRAMENTO CA
95816-6004
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-262-9301
  • Fax: 916-262-9305
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT517
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT 517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: