Healthcare Provider Details

I. General information

NPI: 1043732514
Provider Name (Legal Business Name): STANTON SWANSON MS, OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2017
Last Update Date: 06/09/2024
Certification Date: 06/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 DUNWOODY CHACE
SANDY SPRINGS GA
30328-4587
US

IV. Provider business mailing address

547 92ND AVE N
SAINT PETERSBURG FL
33702-3033
US

V. Phone/Fax

Practice location:
  • Phone: 678-773-9564
  • Fax:
Mailing address:
  • Phone: 678-773-9564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT24976
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT006296
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: