Healthcare Provider Details

I. General information

NPI: 1700012044
Provider Name (Legal Business Name): ANGELA M SWAINSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 US ROUTE 1
BUCKSPORT ME
04416-4124
US

IV. Provider business mailing address

148 US ROUTE 1
BUCKSPORT ME
04416-4124
US

V. Phone/Fax

Practice location:
  • Phone: 917-803-1727
  • Fax:
Mailing address:
  • Phone: 917-803-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number011521-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: