Provider Demographics
| NPI: | 1588203954 |
|---|---|
| Name: | ADAPTIVE HOME MODIFICATION AND DESIGN, LLC |
| Entity Type: | Organization |
| Organization Name: | ADAPTIVE HOME MODIFICATION AND DESIGN, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OCCUPATIONAL THERAPIST |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | MATTHEW |
| Authorized Official - Middle Name: | S |
| Authorized Official - Last Name: | DIXON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | OTR/L |
| Authorized Official - Phone: | 435-313-2295 |
| Mailing Address - Street 1: | 2144 W RIVERS EDGE LN |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAINT GEORGE |
| Mailing Address - State: | UT |
| Mailing Address - Zip Code: | 84770-1828 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 435-313-2295 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2144 W RIVERS EDGE LN |
| Practice Address - Street 2: | |
| Practice Address - City: | SAINT GEORGE |
| Practice Address - State: | UT |
| Practice Address - Zip Code: | 84770-1828 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 435-313-2295 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-01-02 |
| Last Update Date: | 2020-01-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification | Group - Multi-Specialty |
| No | 225XE1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics | Group - Multi-Specialty |
| No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | Group - Multi-Specialty |
| No | 225XH1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Human Factors | Group - Multi-Specialty |
| No | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision | Group - Multi-Specialty |
| No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
