MEDICARE: NICOLE NEWMAN

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
2	225X00000X	Occupational Therapist	OT011764	OH

General Provider Information

NPI Number	:	1770221095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE NEWMAN

Provider Business Mailing Address
First Line	:	4715 CRANBERRY AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-1314
Country	:	US
Telephone Number	:	330-705-3613
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 N CLEVELAND MASSILLON RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-2423
Country	:	US
Telephone Number	:	330-871-9585
Fax Number	:

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

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	06/06/2022

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Directions to “ NICOLE NEWMAN ” Practice Location

Language	Start Address	Practice Location

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