Provider Demographics
NPI:1548592868
Name:NIX, MARCHETA S (OT)
Entity Type:Individual
Prefix:MRS
First Name:MARCHETA
Middle Name:S
Last Name:NIX
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 1:1153 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7807
Mailing Address - Country:US
Mailing Address - Phone:850-932-6382
Mailing Address - Fax:850-932-9225
Practice Address - Street 1:1008 AIRPORT RD
Practice Address - Street 2:SUITE A
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2823
Practice Address - Country:US
Practice Address - Phone:850-837-3349
Practice Address - Fax:850-837-3158
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2588225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist