Provider Demographics
NPI:1164761854
Name:SYDOW, CARRIE A (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:A
Last Name:SYDOW
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061-1614
Mailing Address - Country:US
Mailing Address - Phone:814-746-5134
Mailing Address - Fax:
Practice Address - Street 1:320 CENTER ST
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1614
Practice Address - Country:US
Practice Address - Phone:814-746-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007189224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant