Provider Demographics
NPI:1801807185
Name:NEWSOM, CINDY JO (OTR)
Entity type:Individual
Prefix:MISS
First Name:CINDY
Middle Name:JO
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-0251
Mailing Address - Country:US
Mailing Address - Phone:740-935-0685
Mailing Address - Fax:740-205-1619
Practice Address - Street 1:4014 BIG PETE RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629-3200
Practice Address - Country:US
Practice Address - Phone:740-935-0683
Practice Address - Fax:740-355-6829
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003086225X00000X
WV1283225XP0200X
KYKY-RO952225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174993901OtherNPI