Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1285304303 |
---|---|
Provider Name | Amber Lashon Dixon |
First Address | Upper Chichester, PA 19061-4029 |
Second Address | Upper Chichester, PA 19061-4029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2021 |
Last Update Date | 20/09/2021 |