Provider Demographics
NPI:1982847380
Name:PERRY-DIX, MARION E (OTR/L/SWC)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:E
Last Name:PERRY-DIX
Suffix:
Gender:F
Credentials:OTR/L/SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9035
Mailing Address - Country:US
Mailing Address - Phone:408-319-0011
Mailing Address - Fax:209-892-0027
Practice Address - Street 1:1146 BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-9035
Practice Address - Country:US
Practice Address - Phone:408-319-0011
Practice Address - Fax:209-892-0027
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist