Basic Information
| Provider Information | |||||||||
| NPI: | 1629736582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BATTLE | ||||||||
| FirstName: | SYDNEY | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13392 HIGHWAY 486 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393504671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014626492 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6600 POPLAR SPRINGS DR | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393051105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014825561 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2021 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.