MEDICARE: MS. LYNN M. SWANSON O.T.R.

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	225XP0200X	Pediatric Occupational Therapist	102462	MN

General Provider Information

NPI Number	:	1487786018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNN M. SWANSON O.T.R.

Provider Business Mailing Address
First Line	:	8204 THOMAS AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55444-1524
Country	:	US
Telephone Number	:	763-560-6040
Fax Number	:

Provider Business Practice Location Address
First Line	:	13750 CROSSTOWN DR NW
Second Line	:
City	:	ANDOVER
State	:	MN
Zip	:	55304-5853
Country	:	US
Telephone Number	:	763-755-4275
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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