MEDICARE: MS. CHERIE NEWTON OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	7110	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	155NX	OTHER		BCBS

General Provider Information

NPI Number	:	1649419987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERIE NEWTON OT

Provider Business Mailing Address
First Line	:	7902 CREEDMOOR RD
Second Line	:	SUITE 101
City	:	RALEIGH
State	:	NC
Zip	:	27613-1695
Country	:	US
Telephone Number	:	919-844-1100
Fax Number	:	919-844-1102

Provider Business Practice Location Address
First Line	:	7902 CREEDMOOR RD
Second Line	:	SUITE 101
City	:	RALEIGH
State	:	NC
Zip	:	27613-1695
Country	:	US
Telephone Number	:	919-844-1100
Fax Number	:	919-844-1102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2009
Last Update Date	:	08/16/2016

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