Provider Demographics
NPI:1194297309
Name:SWEETLAND, DEBORAH LYNN
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:SWEETLAND
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 1:15 BRYANT LN
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03748-3305
Mailing Address - Country:US
Mailing Address - Phone:952-270-4205
Mailing Address - Fax:
Practice Address - Street 1:15 BRYANT LN
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NH
Practice Address - Zip Code:03748-3305
Practice Address - Country:US
Practice Address - Phone:952-270-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2426225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist