Provider Demographics
NPI:1609456573
Name:SMITH, SYDNEY LYNN (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:SYDNEY
Middle Name:LYNN
Last Name:SMITH
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:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:GILBERTVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50634-0372
Mailing Address - Country:US
Mailing Address - Phone:816-456-8246
Mailing Address - Fax:
Practice Address - Street 1:502 BUTLER ST
Practice Address - Street 2:
Practice Address - City:ACKLEY
Practice Address - State:IA
Practice Address - Zip Code:50601-1730
Practice Address - Country:US
Practice Address - Phone:641-847-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist