Provider Demographics
NPI:1699016022
Name:SWANSON, JENNA BETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:BETH
Last Name:SWANSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:BETH
Other - Last Name:LAVENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1106 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:SD
Mailing Address - Zip Code:57445-2172
Mailing Address - Country:US
Mailing Address - Phone:605-397-2365
Mailing Address - Fax:
Practice Address - Street 1:1106 N 2ND ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:SD
Practice Address - Zip Code:57445-2172
Practice Address - Country:US
Practice Address - Phone:605-397-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0864225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist