Provider Demographics
NPI:1073572467
Name:SWEENEY, JONATHAN TODD (OT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TODD
Last Name:SWEENEY
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 1:3955 INDIAN RIVER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4845
Mailing Address - Country:US
Mailing Address - Phone:772-569-2330
Mailing Address - Fax:772-569-2630
Practice Address - Street 1:3955 INDIAN RIVER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4845
Practice Address - Country:US
Practice Address - Phone:772-569-2330
Practice Address - Fax:772-569-2630
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009876-1225XH1200X
FLOT25718225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4490Medicare PIN