Provider Demographics
NPI:1295224301
Name:LAY, DIXIE PAMELA-GAYLE
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:PAMELA-GAYLE
Last Name:LAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BOXELDER CT
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-3847
Mailing Address - Country:US
Mailing Address - Phone:850-304-1133
Mailing Address - Fax:
Practice Address - Street 1:3 BOXELDER CT
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-3847
Practice Address - Country:US
Practice Address - Phone:850-304-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician