Provider Demographics
NPI:1134740632
Name:NEWBERRY, KERRIN
Entity type:Individual
Prefix:
First Name:KERRIN
Middle Name:
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERRIN
Other - Middle Name:
Other - Last Name:SWEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4080 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-8459
Mailing Address - Country:US
Mailing Address - Phone:407-969-8424
Mailing Address - Fax:
Practice Address - Street 1:4080 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8459
Practice Address - Country:US
Practice Address - Phone:407-969-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist