Healthcare Provider Details

I. General information

NPI: 1306709654
Provider Name (Legal Business Name): SYDNEY D UTTERBACK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 MICHAEL DR
CHESTERTON IN
46304-2694
US

IV. Provider business mailing address

2283 MCCOOL RD
PORTAGE IN
46368-2649
US

V. Phone/Fax

Practice location:
  • Phone: 219-395-2013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31008859
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: