Provider Demographics
NPI:1699022384
Name:DORROUGH, SYDNEY JANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:JANE
Last Name:DORROUGH
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 1:15016 W 710 RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-0679
Mailing Address - Country:US
Mailing Address - Phone:918-822-0883
Mailing Address - Fax:
Practice Address - Street 1:15016 W 710 RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-0679
Practice Address - Country:US
Practice Address - Phone:918-822-0883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist