Provider Demographics
NPI:1598425019
Name:BEADLES, SYDNEY PAIGE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:PAIGE
Last Name:BEADLES
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 1:1280 E STRINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2490
Mailing Address - Country:US
Mailing Address - Phone:801-213-8880
Mailing Address - Fax:
Practice Address - Street 1:1280 E STRINGHAM AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2490
Practice Address - Country:US
Practice Address - Phone:801-213-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11921630-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist