Provider Demographics
NPI:1891810271
Name:SWENERTON, STEVEN (OT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SWENERTON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 EUBANK BLVD NE
Mailing Address - Street 2:AZTEC COMPLEX
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1312
Mailing Address - Country:US
Mailing Address - Phone:505-298-6752
Mailing Address - Fax:
Practice Address - Street 1:2611 EUBANK BLVD NE
Practice Address - Street 2:AZTEC COMPLEX
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1312
Practice Address - Country:US
Practice Address - Phone:505-298-6752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH 3098Medicaid