Healthcare Provider Details

I. General information

NPI: 1225013030
Provider Name (Legal Business Name): CAROLYN ALENE NEWMAN MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST LAWRENCE J. ELLISON BUILDING , SUITE 1100
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

2169 MABRY DR
SACRAMENTO CA
95835-2115
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6715
  • Fax: 916-734-7144
Mailing address:
  • Phone: 916-928-1959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number1835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: