MEDICARE: MARTIN W DIXON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1033829866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN W DIXON

Provider Business Mailing Address
First Line	:	6605 RETTON RD
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-2849
Country	:	US
Telephone Number	:	267-536-8376
Fax Number	:

Provider Business Practice Location Address
First Line	:	2438 KIMBERLY WOODS DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4290
Country	:	US
Telephone Number	:	614-844-3800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2022
Last Update Date	:	12/02/2022

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Directions to “ MARTIN W DIXON ” Practice Location

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