Provider Demographics
NPI:1356818355
Name:CUSENTINO, SYDNEY MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MARIE
Last Name:CUSENTINO
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 1:1135 S DELANO CT E APT E709
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3457
Mailing Address - Country:US
Mailing Address - Phone:773-507-3652
Mailing Address - Fax:
Practice Address - Street 1:7929 W CERMAK RD STE C
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1378
Practice Address - Country:US
Practice Address - Phone:708-442-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist