Provider Demographics
NPI:1144674730
Name:HIXSON, CARRIE LYNN (COTA)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYNN
Last Name:HIXSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:SANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1155 CALVARY RD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:VA
Mailing Address - Zip Code:24520-3485
Mailing Address - Country:US
Mailing Address - Phone:434-446-5852
Mailing Address - Fax:
Practice Address - Street 1:625 PINEY FOREST RD STE 407
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2870
Practice Address - Country:US
Practice Address - Phone:434-779-7732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPO008394224Z00000X
VA0131001678224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant