Healthcare Provider Details

I. General information

NPI: 1235413832
Provider Name (Legal Business Name): ELIZABETH GRACE SWOPE MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2011
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BAKER BLVD SUITE1
FAIRLAWN OH
44333-3674
US

IV. Provider business mailing address

50 BAKER BLVD STE 4
FAIRLAWN OH
44333-3635
US

V. Phone/Fax

Practice location:
  • Phone: 330-865-1600
  • Fax:
Mailing address:
  • Phone: 330-564-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: