Provider Demographics
NPI:1790001337
Name:SWENSON, LORI ELLEN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELLEN
Last Name:SWENSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 ELLIS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8808
Mailing Address - Country:US
Mailing Address - Phone:406-586-5694
Mailing Address - Fax:406-586-5694
Practice Address - Street 1:1532 ELLIS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8808
Practice Address - Country:US
Practice Address - Phone:406-586-5694
Practice Address - Fax:406-586-5694
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist