Provider Demographics
NPI:1396972824
Name:NEWMAN, COREY LYNN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:COREY
Middle Name:LYNN
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:COREY
Other - Middle Name:LYNN
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:7110 BRIGHTON PARK DR
Mailing Address - Street 2:SUITE 400 PMB 168
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7987
Mailing Address - Country:US
Mailing Address - Phone:704-965-0783
Mailing Address - Fax:
Practice Address - Street 1:7110 BRIGHTON PARK DR
Practice Address - Street 2:SUITE 400 PMB 168
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-7987
Practice Address - Country:US
Practice Address - Phone:704-965-0783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6226225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics