MEDICARE: SYDNEY DANIELLE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1912794454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY DANIELLE SMITH

Provider Business Mailing Address
First Line	:	PO BOX 272
Second Line	:
City	:	DUGGER
State	:	IN
Zip	:	47848-0272
Country	:	US
Telephone Number	:	812-798-9146
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 W NORTHWOOD DR
Second Line	:
City	:	SULLIVAN
State	:	IN
Zip	:	47882-7515
Country	:	US
Telephone Number	:	812-268-3351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/21/2025

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Directions to “ SYDNEY DANIELLE SMITH ” Practice Location

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