Provider Demographics
NPI:1144439688
Name:NEWSOME, TERESA (IECE)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:HAROLD
Mailing Address - State:KY
Mailing Address - Zip Code:41635-0714
Mailing Address - Country:US
Mailing Address - Phone:606-454-5762
Mailing Address - Fax:606-587-1991
Practice Address - Street 1:767 FRASURE BR
Practice Address - Street 2:
Practice Address - City:GRETHEL
Practice Address - State:KY
Practice Address - Zip Code:41631-6311
Practice Address - Country:US
Practice Address - Phone:606-454-5762
Practice Address - Fax:606-587-1991
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist