Healthcare Provider Details

I. General information

NPI: 1235461617
Provider Name (Legal Business Name): MRS. ANGELA KAY NEWBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7848 LEONA ST
SAINT LOUIS MO
63123-7725
US

IV. Provider business mailing address

7848 LEONA ST
SAINT LOUIS MO
63123-7725
US

V. Phone/Fax

Practice location:
  • Phone: 314-791-2586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: