Provider Demographics
NPI:1184865453
Name:MIXON, SABRA ANN (MOTR)
Entity Type:Individual
Prefix:
First Name:SABRA
Middle Name:ANN
Last Name:MIXON
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:SABRA
Other - Middle Name:ANN
Other - Last Name:KURTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:5813 ESPLANADE DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4113
Practice Address - Country:US
Practice Address - Phone:361-991-9600
Practice Address - Fax:361-980-8989
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107423225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist