Healthcare Provider Details

I. General information

NPI: 1073572467
Provider Name (Legal Business Name): JONATHAN TODD SWEENEY OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 INDIAN RIVER BLVD STE 110
VERO BEACH FL
32960-4845
US

IV. Provider business mailing address

3955 INDIAN RIVER BLVD STE 110
VERO BEACH FL
32960-4845
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-2330
  • Fax: 772-569-2630
Mailing address:
  • Phone: 772-569-2330
  • Fax: 772-569-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number009876-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT25718
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: