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General NPI Number Information
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NPI Number | 1194439620
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Entity Type | Individual
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Provider Name | JENNIFER SWINEHART ATC, COF
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Gender | Female
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 525 N MAIN ST STE 270
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City | MILFORD
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State | MI
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Zip | 48381-1595
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Country | US
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Telephone | 248-378-1333
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Fax |
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Provider Business Mailing Address
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Address Line | 3187 TURNBERRY DR
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City | WHITE LAKE
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State | MI
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Zip | 48383-3948
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Country | US
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Telephone | 248-818-7369
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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 | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0895025557
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License Number State | MI
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