Healthcare Provider Details

I. General information

NPI: 1134756919
Provider Name (Legal Business Name): CATHERINE SWANSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 E PARKDALE AVE
MANISTEE MI
49660-9110
US

IV. Provider business mailing address

8940 GLOVERS LAKE RD
BEAR LAKE MI
49614-9622
US

V. Phone/Fax

Practice location:
  • Phone: 231-723-4264
  • Fax:
Mailing address:
  • Phone: 734-846-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010871
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: