Provider Demographics
NPI:1174271449
Name:NIXON, KATLYN SMALL (OT)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:SMALL
Last Name:NIXON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 ACADEMY ST S STE G
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3200
Mailing Address - Country:US
Mailing Address - Phone:252-276-2194
Mailing Address - Fax:252-276-2218
Practice Address - Street 1:312 ACADEMY ST S STE G
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3200
Practice Address - Country:US
Practice Address - Phone:252-276-2194
Practice Address - Fax:252-276-2218
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10831225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist