Healthcare Provider Details

I. General information

NPI: 1215868054
Provider Name (Legal Business Name): SYDNEY CHRISTINE FEDDERLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 E MAIN ST STE B
ST CHARLES IL
60174-2488
US

IV. Provider business mailing address

286 HAMPTON RD
SUGAR GROVE IL
60554-9424
US

V. Phone/Fax

Practice location:
  • Phone: 630-584-7530
  • Fax:
Mailing address:
  • Phone: 630-770-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.027024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: