Provider Demographics
NPI:1689461287
Name:NIXON, TAYLOR DENISE (PTA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DENISE
Last Name:NIXON
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17585 BRISTLECONE RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:OK
Mailing Address - Zip Code:74445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17585 BRISTLECONE RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:OK
Practice Address - Zip Code:74445
Practice Address - Country:US
Practice Address - Phone:918-752-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3769225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant