1083656649 NPI number — AMANDA TAYLOR DIXON MS, OT, CHT

Table of content: AMANDA TAYLOR DIXON MS, OT, CHT (NPI 1083656649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083656649 NPI number — AMANDA TAYLOR DIXON MS, OT, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
AMANDA
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, OT, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
AMANDA
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, OT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083656649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6397 LEE HWY STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-4915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-238-7217
Provider Business Mailing Address Fax Number:
423-238-7217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N FLORIDA ST STE 31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36607-3010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-300-8874
Provider Business Practice Location Address Fax Number:
251-308-3126
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  2182 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com