Provider Demographics
NPI:1497218671
Name:HIXSON, MICHELLE LORAINE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LORAINE
Last Name:HIXSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SHADY SUMMIT WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-4873
Mailing Address - Country:US
Mailing Address - Phone:937-371-8741
Mailing Address - Fax:
Practice Address - Street 1:2722 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-1977
Practice Address - Country:US
Practice Address - Phone:919-863-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10023224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant