MEDICARE: MRS. TESSA DIXON LMT

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	225700000X	Massage Therapist	2010-2712	WV

General Provider Information

NPI Number	:	1124464433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TESSA DIXON LMT

Provider Business Mailing Address
First Line	:	3953 COAL LICK RD
Second Line	:
City	:	ALBRIGHT
State	:	WV
Zip	:	26519-7617
Country	:	US
Telephone Number	:	304-329-0639
Fax Number	:

Provider Business Practice Location Address
First Line	:	3953 COAL LICK RD
Second Line	:
City	:	ALBRIGHT
State	:	WV
Zip	:	26519-7617
Country	:	US
Telephone Number	:	304-329-0639
Fax Number	:

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

Provider Enumeration Date	:	05/14/2013
Last Update Date	:	05/14/2013

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