Provider Demographics
NPI:1033597984
Name:SWANSON, DAVID (COTA/L)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SWANSON
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 140TH AVE NE
Mailing Address - Street 2:STE E110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1862
Mailing Address - Country:US
Mailing Address - Phone:425-644-4100
Mailing Address - Fax:
Practice Address - Street 1:126 15TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3409
Practice Address - Country:US
Practice Address - Phone:253-445-8663
Practice Address - Fax:253-445-8342
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00001145224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant