Provider Demographics
NPI:1942227962
Name:NIXSON, LINDA DIANE (OTR/L)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANE
Last Name:NIXSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3193 BELLFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-3033
Mailing Address - Country:US
Mailing Address - Phone:863-647-2268
Mailing Address - Fax:863-647-2268
Practice Address - Street 1:3317 US HIGHWAY 98 S
Practice Address - Street 2:STE. 6
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-8365
Practice Address - Country:US
Practice Address - Phone:863-667-3092
Practice Address - Fax:863-667-3142
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist