Provider Demographics
NPI:1851629943
Name:HIXSON, KALEY ANNE (CMT)
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:ANNE
Last Name:HIXSON
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 1:3456 E 12 MILE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2511
Mailing Address - Country:US
Mailing Address - Phone:586-573-8100
Mailing Address - Fax:586-573-8101
Practice Address - Street 1:3456 E 12 MILE RD STE 2
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2511
Practice Address - Country:US
Practice Address - Phone:586-573-8100
Practice Address - Fax:586-573-8101
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist