Provider Demographics
NPI:1699915991
Name:DIXON, TARA L (RRT)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:L
Last Name:DIXON
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:L
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 356172
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6172
Mailing Address - Country:US
Mailing Address - Phone:206-598-4444
Mailing Address - Fax:206-598-4247
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356172
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6172
Practice Address - Country:US
Practice Address - Phone:206-598-4444
Practice Address - Fax:206-598-4247
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALR00002120227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered