Provider Demographics
NPI:1316087539
Name:SWARTZ, SUSAN PATRICIA (OTRL)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:PATRICIA
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CREEKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-4111
Mailing Address - Country:US
Mailing Address - Phone:919-649-0525
Mailing Address - Fax:919-370-7436
Practice Address - Street 1:310 LLOYD ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1824
Practice Address - Country:US
Practice Address - Phone:919-929-9998
Practice Address - Fax:919-929-8188
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5942225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142YCOtherBLUE CROSS
NC7301927Medicaid