Provider Demographics
NPI:1003405036
Name:KOOGLE, SYDNEY CAITLIN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:CAITLIN
Last Name:KOOGLE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:CAITLIN
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:264 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1989
Mailing Address - Country:US
Mailing Address - Phone:937-256-4663
Mailing Address - Fax:
Practice Address - Street 1:264 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1989
Practice Address - Country:US
Practice Address - Phone:937-256-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010684225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist