Provider Demographics
NPI:1720399637
Name:SWANSON, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 COUNTY RT 20
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12422-5205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4522 COUNTY RT 20
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NY
Practice Address - Zip Code:12422-5205
Practice Address - Country:US
Practice Address - Phone:518-239-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004791-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics