Provider Demographics
NPI:1871363366
Name:NIX, TERRI L (COTA)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:NIX
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 SHADY LN APT 1005
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6435
Mailing Address - Country:US
Mailing Address - Phone:817-525-5307
Mailing Address - Fax:
Practice Address - Street 1:1360 SHADY LN APT 1005
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6435
Practice Address - Country:US
Practice Address - Phone:817-525-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215320224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant