Healthcare Provider Details

I. General information

NPI: 1932046588
Provider Name (Legal Business Name): ELIZABETH MARY NEWPORT OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

842 E RUSH CT
NIXA MO
65714-7983
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-6000
  • Fax:
Mailing address:
  • Phone: 417-920-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2018006143
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: