Provider Demographics
NPI:1639628902
Name:HIXON-SMITH, KATHIE KAY (CMT)
Entity Type:Individual
Prefix:MRS
First Name:KATHIE
Middle Name:KAY
Last Name:HIXON-SMITH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6514
Mailing Address - Country:US
Mailing Address - Phone:612-703-3295
Mailing Address - Fax:
Practice Address - Street 1:1704 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6514
Practice Address - Country:US
Practice Address - Phone:612-703-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist