Provider Demographics
NPI:1437769114
Name:MERICLE, SYDNEY CHRISTINE
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:CHRISTINE
Last Name:MERICLE
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 1:4301 173RD STREET CT N
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-9796
Mailing Address - Country:US
Mailing Address - Phone:309-235-7177
Mailing Address - Fax:
Practice Address - Street 1:500 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:IL
Practice Address - Zip Code:61270-3004
Practice Address - Country:US
Practice Address - Phone:815-772-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist