Provider Demographics
NPI:1871228767
Name:NEWSOME, ALLIE KAYE (COTA/L)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:KAYE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 PARKS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-8266
Mailing Address - Country:US
Mailing Address - Phone:336-247-9914
Mailing Address - Fax:
Practice Address - Street 1:801 GREENHAVEN DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-7103
Practice Address - Country:US
Practice Address - Phone:336-292-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15234224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant