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General NPI Number Information
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NPI Number | 1134896491
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Entity Type | Individual
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Provider Name | NICOLE SWANK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 2800 S 2ND ST STE B
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City | CABOT
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State | AR
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Zip | 72023-7030
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Country | US
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Telephone | 501-286-6075
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Fax |
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Provider Business Mailing Address
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Address Line | 3832 CENTER ST
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City | LIVONIA
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State | NY
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Zip | 14487-9553
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR3527
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License Number State | AR
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