Provider Demographics
NPI:1134756919
Name:SWANSON, CATHERINE (OTR/L)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SWANSON
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 1:8940 GLOVERS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BEAR LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49614-9622
Mailing Address - Country:US
Mailing Address - Phone:734-846-1177
Mailing Address - Fax:
Practice Address - Street 1:10781 E CHERRY BEND RD # STUDIO8A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5249
Practice Address - Country:US
Practice Address - Phone:616-460-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010871225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist