Provider Demographics
NPI:1306851969
Name:SWIDER, ROBERT (OTR/L, CHT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SWIDER
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0083
Mailing Address - Country:US
Mailing Address - Phone:208-651-4551
Mailing Address - Fax:
Practice Address - Street 1:920 W IRONWOOD DR STE 207
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2643
Practice Address - Country:US
Practice Address - Phone:208-664-0575
Practice Address - Fax:208-664-0576
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-705225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
16541982Medicare UPIN