Provider Demographics
NPI:1356049423
Name:MEHRHOFF, SIDNEY ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:ANN
Last Name:MEHRHOFF
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40999 SESTAK RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65074-3187
Mailing Address - Country:US
Mailing Address - Phone:573-821-2937
Mailing Address - Fax:
Practice Address - Street 1:619 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-2546
Practice Address - Country:US
Practice Address - Phone:573-557-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022040742224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant