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NPI Code Detail

MEDICARE: LORI SWANSON OTR

MEDICARE: LORI SWANSON OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5201005166MI

General Provider Information

NPI Number : 1255803128
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI SWANSON OTR
Provider Business Mailing Address
First Line : 7801 ACORN CT
Second Line :
City : BIRCH RUN
State : MI
Zip : 48415-9247
Country : US
Telephone Number : 989-295-0272
Fax Number :
Provider Business Practice Location Address
First Line : 9317 VIENNA RD
Second Line :
City : MONTROSE
State : MI
Zip : 48457-9729
Country : US
Telephone Number : 810-639-6171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2018
Last Update Date : 12/17/2018

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