Provider Demographics
NPI:1992203525
Name:NEWBERG, AUSTYNNE MARGARET (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:AUSTYNNE
Middle Name:MARGARET
Last Name:NEWBERG
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 RFD
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-7919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:424 N RAND RD
Practice Address - Street 2:
Practice Address - City:NORTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1496
Practice Address - Country:US
Practice Address - Phone:847-756-2680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012332225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist