Provider Demographics
NPI:1417179417
Name:DIXON, SUSAN MICHELLE (OT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MICHELLE
Last Name:DIXON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 NE 70TH ST.
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5749
Mailing Address - Country:US
Mailing Address - Phone:206-527-4938
Mailing Address - Fax:206-774-0733
Practice Address - Street 1:1718 NE 70TH ST.
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5749
Practice Address - Country:US
Practice Address - Phone:206-527-4938
Practice Address - Fax:206-774-0733
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist