MEDICARE: ALEXIS SWASEY

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	222Q00000X	Developmental Therapist
2	247200000X	Other Technician

General Provider Information

NPI Number	:	1407216807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS SWASEY

Provider Business Mailing Address
First Line	:	3280 S ORCHARD ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3280 S ORCHARD ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3343
Country	:	US
Telephone Number	:	702-525-5723
Fax Number	:

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

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	02/26/2016

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Directions to “ ALEXIS SWASEY ” Practice Location

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