Provider Demographics
NPI:1891950507
Name:DIXON, CRYSTAL RENEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:RENEE
Last Name:DIXON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1386 LITTLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-3300
Mailing Address - Country:US
Mailing Address - Phone:606-205-2678
Mailing Address - Fax:606-589-2522
Practice Address - Street 1:215 RICHARDSON WAY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3803
Practice Address - Country:US
Practice Address - Phone:606-205-2678
Practice Address - Fax:606-589-2522
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3440225X00000X
TN4781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist