Provider Demographics
NPI:1124414172
Name:SYKORA, KACEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:SYKORA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:
Other - Last Name:TOMCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:141 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601
Mailing Address - Country:US
Mailing Address - Phone:701-590-9116
Mailing Address - Fax:701-483-4281
Practice Address - Street 1:141 3RD ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601
Practice Address - Country:US
Practice Address - Phone:701-590-9116
Practice Address - Fax:701-483-4281
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1404225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics