Provider Demographics
NPI:1588044663
Name:SWANSON, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:SALINAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:9120 RIPPLE RIDGE AVE
Mailing Address - Street 2:#101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-2948
Mailing Address - Country:US
Mailing Address - Phone:949-463-0567
Mailing Address - Fax:
Practice Address - Street 1:9120 RIPPLE RIDGE AVE
Practice Address - Street 2:#101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-2948
Practice Address - Country:US
Practice Address - Phone:949-463-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15-0578225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics