Provider Demographics
NPI:1902362916
Name:BEAULAC, SYDNEY BRANSON (OTR/L)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:BRANSON
Last Name:BEAULAC
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 1:136 CRYSTLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7569
Mailing Address - Country:US
Mailing Address - Phone:919-741-7876
Mailing Address - Fax:
Practice Address - Street 1:3000 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4504
Practice Address - Country:US
Practice Address - Phone:919-684-3733
Practice Address - Fax:919-681-7574
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005821225X00000X
NC15280225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist