Provider Demographics
NPI:1154591253
Name:DIXON, RUTHELLEN GRACE (OTR)
Entity type:Individual
Prefix:
First Name:RUTHELLEN
Middle Name:GRACE
Last Name:DIXON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 96TH ST
Mailing Address - Street 2:APT 3 F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6555
Mailing Address - Country:US
Mailing Address - Phone:917-822-4694
Mailing Address - Fax:
Practice Address - Street 1:537 BANTA STREET
Practice Address - Street 2:PROGRESSIVE REHAB AND HOME CRAE, PT&OT,PLLC
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-803-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014960225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist