Healthcare Provider Details

I. General information

NPI: 1932026325
Provider Name (Legal Business Name): SYDNEY JO CARLISLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HARBOR BEND CT STE 102
LAKE ST LOUIS MO
63367-1480
US

IV. Provider business mailing address

860 GLEN EAGLE DR
TROY MO
63379-3577
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-2075
  • Fax:
Mailing address:
  • Phone: 217-430-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2026029098
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: