Provider Demographics
NPI:1811493661
Name:DIXON, ANN M (OTR/L)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:DIXON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:MALLOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6328 FAIRMOUNT AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3611
Mailing Address - Country:US
Mailing Address - Phone:510-525-2700
Mailing Address - Fax:510-525-2716
Practice Address - Street 1:6328 FAIRMOUNT AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3611
Practice Address - Country:US
Practice Address - Phone:510-525-2700
Practice Address - Fax:510-525-2716
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17-0983225XH1200X
CA20407225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand