Healthcare Provider Details

I. General information

NPI: 1003039983
Provider Name (Legal Business Name): STEFFANIE SWENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD
REDLANDS CA
92373-4775
US

IV. Provider business mailing address

871 SAINT ANDREWS WAY
BEAUMONT CA
92223-7192
US

V. Phone/Fax

Practice location:
  • Phone: 97-931-0789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2002
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number2002 OT
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: