Provider Demographics
NPI:1053789495
Name:SWENEY, KATIE JEAN (OT)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:JEAN
Last Name:SWENEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:JEAN
Other - Last Name:HUOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-1357
Mailing Address - Country:US
Mailing Address - Phone:320-839-4271
Mailing Address - Fax:320-839-4196
Practice Address - Street 1:15620 EDGEWOOD DR
Practice Address - Street 2:STE 240
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56401-6983
Practice Address - Country:US
Practice Address - Phone:218-454-7012
Practice Address - Fax:218-454-7015
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104976225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist