Provider Demographics
NPI:1669878922
Name:NEWBERN, AMANDA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NEWBERN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:NEWBERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:420 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3931
Mailing Address - Country:US
Mailing Address - Phone:615-893-2602
Mailing Address - Fax:
Practice Address - Street 1:420 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3931
Practice Address - Country:US
Practice Address - Phone:615-893-2602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4468225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist