Healthcare Provider Details

I. General information

NPI: 1801807185
Provider Name (Legal Business Name): CINDY JO NEWSOM OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 BIG PETE RD
FRANKLIN FURNACE OH
45629-3200
US

IV. Provider business mailing address

PO BOX 251
WHEELERSBURG OH
45694-0251
US

V. Phone/Fax

Practice location:
  • Phone: 740-935-0683
  • Fax: 740-355-6829
Mailing address:
  • Phone: 740-935-0685
  • Fax: 740-205-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number003086
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1283
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberKY-RO952
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: