Provider Demographics
NPI:1023750049
Name:GAYTON, SYDNEY (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:GAYTON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E INTERSTATE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1226
Mailing Address - Country:US
Mailing Address - Phone:701-751-1125
Mailing Address - Fax:
Practice Address - Street 1:1600 E INTERSTATE AVE STE 3
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1226
Practice Address - Country:US
Practice Address - Phone:701-751-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1810225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist