Provider Demographics
NPI:1528806452
Name:SWENSON, MAKAYLA JEAN (OT)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:JEAN
Last Name:SWENSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MAKAYLA
Other - Middle Name:JEAN
Other - Last Name:IHDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1257
Mailing Address - Country:US
Mailing Address - Phone:641-628-3150
Mailing Address - Fax:641-628-8901
Practice Address - Street 1:2525 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1553
Practice Address - Country:US
Practice Address - Phone:641-628-6728
Practice Address - Fax:641-628-6727
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist