Provider Demographics
NPI:1124659115
Name:HIXON, TRACEY LYNN
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LYNN
Last Name:HIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 N KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2455
Mailing Address - Country:US
Mailing Address - Phone:937-901-9029
Mailing Address - Fax:
Practice Address - Street 1:1546 MARSETTA DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2733
Practice Address - Country:US
Practice Address - Phone:937-427-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist