Healthcare Provider Details

I. General information

NPI: 1114830585
Provider Name (Legal Business Name): SYDNEY ELIZABETH MAYBAUM MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3596 NE INDIAN RIVER DR
JENSEN BEACH FL
34957-4138
US

IV. Provider business mailing address

3596 NE INDIAN RIVER DR
JENSEN BEACH FL
34957-4138
US

V. Phone/Fax

Practice location:
  • Phone: 407-687-9662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT26661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: