Healthcare Provider Details

I. General information

NPI: 1386041473
Provider Name (Legal Business Name): KYLE SWANSON OT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 LINGLESTOWN RD
HARRISBURG PA
17112-1153
US

IV. Provider business mailing address

6959 WERTZVILLE RD
ENOLA PA
17025-1039
US

V. Phone/Fax

Practice location:
  • Phone: 717-920-5002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126002025
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC018314
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: