Provider Demographics
NPI:1699256610
Name:DIXON, CHEYENNE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41225 SE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9418
Mailing Address - Country:US
Mailing Address - Phone:425-442-6020
Mailing Address - Fax:
Practice Address - Street 1:830 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4513
Practice Address - Country:US
Practice Address - Phone:562-258-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2021-09-30
Deactivation Date:2021-04-28
Deactivation Code:
Reactivation Date:2021-09-30
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA61118578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program