Provider Demographics
NPI:1720861081
Name:NEWBY, MINDY (OTR, ATC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:NEWBY
Suffix:
Gender:F
Credentials:OTR, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-5250
Mailing Address - Country:US
Mailing Address - Phone:208-215-6851
Mailing Address - Fax:
Practice Address - Street 1:418 FLOYDE ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-4508
Practice Address - Country:US
Practice Address - Phone:208-634-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist