Provider Demographics
NPI:1124606231
Name:NEWELL, DESIREE (COTA)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:NEWELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:QUICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:2053 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3915
Mailing Address - Country:US
Mailing Address - Phone:810-513-5450
Mailing Address - Fax:
Practice Address - Street 1:915 N RIVER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-6831
Practice Address - Country:US
Practice Address - Phone:989-781-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202008216224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant