Healthcare Provider Details

I. General information

NPI: 1114098456
Provider Name (Legal Business Name): SHELLY DAWN NEWMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLY KNOTT

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 S. YALE AVE. STE. 102
TULSA OK
74135
US

IV. Provider business mailing address

5110 S. YALE AVE. STE. 102
TULSA OK
74135
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-2386
  • Fax: 918-645-8686
Mailing address:
  • Phone: 918-492-2386
  • Fax: 918-645-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3735
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: