Provider Demographics
NPI:1922665850
Name:DIXON, DOLORES THERESA (COTA)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:THERESA
Last Name:DIXON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BEECHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-2216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 BEECHER AVE
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-2216
Practice Address - Country:US
Practice Address - Phone:267-342-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008476225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist