MEDICARE: MARIE ELIZABETH LOUGHLIN DIXON OTL

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	225XL0004X	Low Vision Occupational Therapist	02414	MD
2	225X00000X	Occupational Therapist	02414	MD

General Provider Information

NPI Number	:	1124461900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE ELIZABETH LOUGHLIN DIXON OTL

Provider Business Mailing Address
First Line	:	6055 CEDAR WOOD DR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3674
Country	:	US
Telephone Number	:	410-650-6885
Fax Number	:	410-650-6886

Provider Business Practice Location Address
First Line	:	6055 CEDAR WOOD DR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3674
Country	:	US
Telephone Number	:	410-650-6885
Fax Number	:	410-650-6886

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

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	01/20/2023

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