Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1226 | SC |
NPI | 1023352168 |
---|---|
Provider Name | Ms. Sylvia Celeste Dixon |
First Address | Darlington, SC 29532-3413 |
Second Address | Sumter, SC 29150-1712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |