Provider Demographics
NPI:1871193193
Name:SWAN, SARAH V (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:V
Last Name:SWAN
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 1:9634 THORSK ST APT 308
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3548
Mailing Address - Country:US
Mailing Address - Phone:609-605-8040
Mailing Address - Fax:
Practice Address - Street 1:12033 SE 265TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030
Practice Address - Country:US
Practice Address - Phone:253-373-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61022833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist