Provider Demographics
NPI:1417334848
Name:DIXON, REBECCA (MS EDUCATION)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8842 STATE ROUTE 90 N
Mailing Address - Street 2:
Mailing Address - City:KING FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:13081-8717
Mailing Address - Country:US
Mailing Address - Phone:315-364-7570
Mailing Address - Fax:315-364-8016
Practice Address - Street 1:8842 STATE ROUTE 90 N
Practice Address - Street 2:
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081-8717
Practice Address - Country:US
Practice Address - Phone:315-364-7570
Practice Address - Fax:315-364-8016
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist