Healthcare Provider Details

I. General information

NPI: 1336984707
Provider Name (Legal Business Name): HEIDI SWANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEIDI MCBAIN OTR/L

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CHESTNUT ST STE 3
DOVER NH
03820-3335
US

IV. Provider business mailing address

1768 STATE RD
ELIOT ME
03903-1087
US

V. Phone/Fax

Practice location:
  • Phone: 603-842-5351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2680
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2680
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: