Basic Information
| Provider Information | |||||||||
| NPI: | 1801052378 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SYLVIA | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | REBECCA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 1ST ST N | ||||||||
| Address2: | SUITE200 | ||||||||
| City: | JACKSONVILLE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322506945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042419231 | ||||||||
| FaxNumber: | 8887945038 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 KIWANIS DR | ||||||||
| Address2: | |||||||||
| City: | FREEPORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610324580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152356196 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 057002996 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | OTA169 | TN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.