MEDICARE: NICOLE JATHO SWANSON MA, 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	OT3354	GA

General Provider Information

NPI Number	:	1396170999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE JATHO SWANSON MA, OTR/L

Provider Business Mailing Address
First Line	:	2608 COMMONS BLVD
Second Line	:	SUITE B
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2080
Country	:	US
Telephone Number	:	706-814-4397
Fax Number	:	706-854-1451

Provider Business Practice Location Address
First Line	:	2608 COMMONS BLVD
Second Line	:	SUITE B
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2080
Country	:	US
Telephone Number	:	706-814-4397
Fax Number	:	706-854-1451

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

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	06/17/2026

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