MEDICARE: MS. TOSHA 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	RBT21-178633

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386379881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TOSHA DIXON

Provider Business Mailing Address
First Line	:	PO BOX 720165
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30358-2165
Country	:	US
Telephone Number	:	305-390-6623
Fax Number	:

Provider Business Practice Location Address
First Line	:	3061 PALM TRACE LANDINGS DR APT 1514
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-1856
Country	:	US
Telephone Number	:	305-390-6623
Fax Number	:

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

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	07/19/2022

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