Provider Demographics
NPI:1114564390
Name:FLEEGE, SYDNEY KATHRYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:KATHRYN
Last Name:FLEEGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7873 LIGHTWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5635
Mailing Address - Country:US
Mailing Address - Phone:312-342-9064
Mailing Address - Fax:
Practice Address - Street 1:7873 LIGHTWOOD WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-5635
Practice Address - Country:US
Practice Address - Phone:312-342-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005315225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist