Healthcare Provider Details

I. General information

NPI: 1235858283
Provider Name (Legal Business Name): SYDNEY CUSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29560 W LAKE MIOLA DR
PAOLA KS
66071-1396
US

IV. Provider business mailing address

29560 W LAKE MIOLA DR
PAOLA KS
66071-1396
US

V. Phone/Fax

Practice location:
  • Phone: 913-742-3238
  • Fax:
Mailing address:
  • Phone: 913-742-3238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-04511
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2025032187
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: