Provider Demographics
NPI:1144918749
Name:NEWTON, JENNY MARIE (COTA)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 MALONE WAY
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5312
Mailing Address - Country:US
Mailing Address - Phone:706-833-0847
Mailing Address - Fax:
Practice Address - Street 1:621 PONDER PLACE DR STE 2
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3121
Practice Address - Country:US
Practice Address - Phone:706-310-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002976224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant