Provider Demographics
NPI:1750976445
Name:SWAGLER, LEXIE DEIDRE
Entity type:Individual
Prefix:
First Name:LEXIE
Middle Name:DEIDRE
Last Name:SWAGLER
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 1:2051 BRIDGE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-9277
Mailing Address - Country:US
Mailing Address - Phone:330-697-0570
Mailing Address - Fax:
Practice Address - Street 1:4761 HIGHWAY 501 STE 1
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-9457
Practice Address - Country:US
Practice Address - Phone:347-891-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6107225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist