=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073572467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN TODD SWEENEY OT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2006
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3955 INDIAN RIVER BLVD STE 110
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-569-2330
-----------------------------------------------------
Fax | 772-569-2630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3955 INDIAN RIVER BLVD STE 110
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-569-2330
-----------------------------------------------------
Fax | 772-569-2630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XH1200X
-----------------------------------------------------
Taxonomy Name | Hand Occupational Therapist
-----------------------------------------------------
License Number | 009876-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XH1200X
-----------------------------------------------------
Taxonomy Name | Hand Occupational Therapist
-----------------------------------------------------
License Number | OT25718
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------