Individual
MRS. SAMANTHA SWENSEN SWENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2915 NORTH 4TH STREET, FLAGSTAFF, AZ 86004
(928) 779-1679
(928) 779-2822
Mailing address
2915 NORTH 4TH STREET, FLAGSTAFF, AZ 86004
(928) 779-1679
(928) 779-2822
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
005129
AZ
225XP0200X
Pediatric Occupational Therapist
Primary
5129
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
692646
—
AZ
01
—
Z155549
MEDICARE PTAN
AZ
Enumeration date
12/21/2006
Last updated
05/08/2021
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