Provider Demographics
NPI:1376151316
Name:DICKSON, LYDIA CHRISTENE
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:CHRISTENE
Last Name:DICKSON
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 1:198 LITTLE RIVER 128
Mailing Address - Street 2:
Mailing Address - City:FOREMAN
Mailing Address - State:AR
Mailing Address - Zip Code:71836-8520
Mailing Address - Country:US
Mailing Address - Phone:903-276-4270
Mailing Address - Fax:
Practice Address - Street 1:198 LITTLE RIVER 128
Practice Address - Street 2:
Practice Address - City:FOREMAN
Practice Address - State:AR
Practice Address - Zip Code:71836-8520
Practice Address - Country:US
Practice Address - Phone:903-276-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist