Provider Demographics
NPI:1871955583
Name:SWARTZEL, STEPHANIE JEAN (COTA/L)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEAN
Last Name:SWARTZEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 COYLE ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7101
Mailing Address - Country:US
Mailing Address - Phone:401-318-8293
Mailing Address - Fax:
Practice Address - Street 1:626 PARK AVE
Practice Address - Street 2:UNIT 2A
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2154
Practice Address - Country:US
Practice Address - Phone:401-270-9991
Practice Address - Fax:401-270-2265
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00806174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOTA00806OtherCOTA