=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407312515
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA ORLENE NEWCOMB PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2019
-----------------------------------------------------
Last Update Date | 02/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1813 PICCARD DR
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-6067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-412-7435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1813 PICCARD DR
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-6067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-412-7435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 222Q00000X
-----------------------------------------------------
Taxonomy Name | Developmental Therapist
-----------------------------------------------------
License Number | PGP-0683016
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------