Healthcare Provider Details

I. General information

NPI: 1477993970
Provider Name (Legal Business Name): JEREMY BRUCE SWART MSOTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

5974 WESCOTT HILLS WAY
ALEXANDRIA VA
22315-4743
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT010000810
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: