Provider Demographics
NPI:1821783762
Name:HARTMAN, SYDNEY ELIZABETH (COTA)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ELIZABETH
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 BETHANY LN
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2302
Mailing Address - Country:US
Mailing Address - Phone:618-670-1341
Mailing Address - Fax:
Practice Address - Street 1:1405 N 2ND ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-4213
Practice Address - Country:US
Practice Address - Phone:618-233-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023010801224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant