Provider Demographics
NPI:1467519199
Name:SWANEPOEL, INGRID ESTELLE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:ESTELLE
Last Name:SWANEPOEL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 N MAPLE AVE
Mailing Address - Street 2:#104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8009
Mailing Address - Country:US
Mailing Address - Phone:559-325-3503
Mailing Address - Fax:559-325-3504
Practice Address - Street 1:7005 N MAPLE AVE
Practice Address - Street 2:#104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8009
Practice Address - Country:US
Practice Address - Phone:559-325-3503
Practice Address - Fax:559-325-3504
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2917225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ24504ZMedicare ID - Type Unspecified