Provider Demographics
NPI:1467849562
Name:SIDNEY, CORINNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:SIDNEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 504469
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4469
Mailing Address - Country:US
Mailing Address - Phone:217-402-9646
Mailing Address - Fax:
Practice Address - Street 1:302 BURWASH AVE
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9572
Practice Address - Country:US
Practice Address - Phone:217-402-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.010086225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist