Provider Demographics
NPI:1750859252
Name:SWENSON, TERRA LEAHANN (COTA, CLT)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:LEAHANN
Last Name:SWENSON
Suffix:
Gender:F
Credentials:COTA, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 CALOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-8633
Mailing Address - Country:US
Mailing Address - Phone:561-722-7510
Mailing Address - Fax:
Practice Address - Street 1:250 W INDIANTOWN RD STE 106
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3549
Practice Address - Country:US
Practice Address - Phone:561-768-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA16775224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA16775OtherPROFESSIONAL LICENSE