MEDICARE: MS. MARY E SWANSON MOT, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056012915	IL

General Provider Information

NPI Number	:	1356959738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY E SWANSON MOT, OTR/L

Provider Business Mailing Address
First Line	:	4710 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2453
Country	:	US
Telephone Number	:	708-422-2960
Fax Number	:	708-422-3001

Provider Business Practice Location Address
First Line	:	4710 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2453
Country	:	US
Telephone Number	:	708-422-2960
Fax Number	:	708-422-3001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2020
Last Update Date	:	06/23/2021

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