Provider Demographics
NPI:1912303371
Name:NIXON, MARY (OTD, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:RIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:4201 LAKE BOONE TRL
Mailing Address - Street 2:STE 4
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7512
Mailing Address - Country:US
Mailing Address - Phone:919-781-4434
Mailing Address - Fax:919-781-5851
Practice Address - Street 1:4201 LAKE BOONE TRL
Practice Address - Street 2:STE 4
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7512
Practice Address - Country:US
Practice Address - Phone:919-781-4434
Practice Address - Fax:919-781-5851
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9417225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist