Provider Demographics
NPI:1356959738
Name:SWANSON, MARY E (MOT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2453
Mailing Address - Country:US
Mailing Address - Phone:708-422-2960
Mailing Address - Fax:708-422-3001
Practice Address - Street 1:4710 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2453
Practice Address - Country:US
Practice Address - Phone:708-422-2960
Practice Address - Fax:708-422-3001
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056012915225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist