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General NPI Number Information
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NPI Number | 1568781110
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Entity Type | Individual
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Provider Name | SANDRA DIXON
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Gender | Female
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 156 HAVEN ST
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City | COTTAGE HILLS
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State | IL
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Zip | 62018-1243
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Country | US
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Telephone | 618-259-2992
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Fax |
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Provider Business Mailing Address
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Address Line | 156 HAVEN ST
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City | COTTAGE HILLS
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State | IL
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Zip | 62018-1243
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2010007408
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.003215
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License Number State | IL
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