Provider Demographics
NPI:1427268721
Name:NEWTON, TRAVIS JAMES (OTRL CLT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JAMES
Last Name:NEWTON
Suffix:
Gender:M
Credentials:OTRL CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 ALTURAS DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4906
Mailing Address - Country:US
Mailing Address - Phone:208-539-2784
Mailing Address - Fax:
Practice Address - Street 1:1897 ALTURAS DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4906
Practice Address - Country:US
Practice Address - Phone:208-539-2784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT618225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist