Provider Demographics
NPI:1609369917
Name:ANDERSON, SYDNEY ERIN (OT, MOT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ERIN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OT, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:101 W 92 HWY STE H
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060
Practice Address - Country:US
Practice Address - Phone:816-903-0777
Practice Address - Fax:816-903-0776
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03484225X00000X
MO2018028956225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist