Provider Demographics
NPI:1396034583
Name:DIXON-GARRICK, ANGIE D (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:D
Last Name:DIXON-GARRICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1030 JEFFERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:576 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-1373
Practice Address - Country:US
Practice Address - Phone:757-314-7522
Practice Address - Fax:757-314-7524
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002964225X00000X
TN0000006256225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist