Provider Demographics
NPI:1437405008
Name:SEXTON, KELLY DIXON (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DIXON
Last Name:SEXTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1909
Mailing Address - Country:US
Mailing Address - Phone:423-698-0802
Mailing Address - Fax:
Practice Address - Street 1:425 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1909
Practice Address - Country:US
Practice Address - Phone:423-698-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2885OtherOTR/L