Provider Demographics
NPI:1932369790
Name:MCREYNOLDS, SIDNEY MARIE (MORT/L)
Entity Type:Individual
Prefix:MRS
First Name:SIDNEY
Middle Name:MARIE
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:MORT/L
Other - Prefix:MRS
Other - First Name:SIDNEY
Other - Middle Name:MARIE
Other - Last Name:THORGRAMSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:11850 SW ALLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4805
Mailing Address - Country:US
Mailing Address - Phone:503-646-7164
Mailing Address - Fax:
Practice Address - Street 1:11850 SW ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4805
Practice Address - Country:US
Practice Address - Phone:503-646-7164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR227698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist