Provider Demographics
NPI:1164066361
Name:SARGEANT, DAYLE EVELYN PERRY
Entity Type:Individual
Prefix:
First Name:DAYLE
Middle Name:EVELYN PERRY
Last Name:SARGEANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S GROVE ST APT 5
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-3401
Mailing Address - Country:US
Mailing Address - Phone:802-881-3130
Mailing Address - Fax:
Practice Address - Street 1:104 S GROVE ST APT 5
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-3401
Practice Address - Country:US
Practice Address - Phone:802-881-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty