Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 2698 | AK |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2698 | AK |
NPI | 1033546841 |
---|---|
Provider Name | Marie Koleka Swanson |
First Address | Anchorage, AK 99518-3330 |
Second Address | Anchorage, AK 99518-3330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2013 |
Last Update Date | 05/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
536 | STATE OF ALASKA OT LICENSE (01) | AK |