Provider Demographics
NPI:1710756580
Name:NEWMAN, JORDAN HOWARD (OTR/L)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:HOWARD
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 VILLAGE PROFESSIONAL DR N
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4734
Mailing Address - Country:US
Mailing Address - Phone:334-528-1964
Mailing Address - Fax:334-528-4610
Practice Address - Street 1:2450 VILLAGE PROFESSIONAL DR N
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4734
Practice Address - Country:US
Practice Address - Phone:334-528-1964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist