Individual
MS. AMY NEWSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
825 NEW YORK DR, VANDALIA, IL 62471-1044
(618) 283-5545
(618) 283-2951
Mailing address
RR 2 BOX 268, VANDALIA, IL 62471-9542
(618) 283-1232
(618) 283-4933
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376012895001
—
IL
Enumeration date
06/15/2007
Last updated
07/08/2007
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