Provider Demographics
NPI:1043047624
Name:ABBOTT, SYDNEY ELAINE (OTD, OTR)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ELAINE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JACKSON ST APT 241
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6769
Mailing Address - Country:US
Mailing Address - Phone:317-474-9325
Mailing Address - Fax:
Practice Address - Street 1:9423 N STATE ROAD 9
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:IN
Practice Address - Zip Code:47246-9760
Practice Address - Country:US
Practice Address - Phone:812-546-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008066A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics