Provider Demographics
NPI:1114098456
Name:NEWMAN, SHELLY DAWN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:DAWN
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:KNOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5110 S. YALE AVE.
Mailing Address - Street 2:STE. 102
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135
Mailing Address - Country:US
Mailing Address - Phone:918-492-2386
Mailing Address - Fax:918-645-8686
Practice Address - Street 1:5110 S. YALE AVE.
Practice Address - Street 2:STE. 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-492-2386
Practice Address - Fax:918-645-8686
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3735225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301241Medicaid