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NPI Code Detail

MEDICARE: ROBERT LYLE SWANSON COTA/L

MEDICARE: ROBERT LYLE SWANSON COTA/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
1224Z00000XOccupational Therapy Assistant057.001811IL

General Provider Information

NPI Number : 1821359324
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT LYLE SWANSON COTA/L
Provider Business Mailing Address
First Line : 5050 SUMMIT AVE
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62203-1026
Country : US
Telephone Number : 618-874-3597
Fax Number : 618-874-8212
Provider Business Practice Location Address
First Line : 5050 SUMMIT AVE
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62203-1026
Country : US
Telephone Number : 618-874-3597
Fax Number : 618-874-8212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2012
Last Update Date : 05/31/2012

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Directions to “ ROBERT LYLE SWANSON COTA/L” Practice Location

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