Healthcare Provider Details

I. General information

NPI: 1326978644
Provider Name (Legal Business Name): SYDNEY RAE STEPHENS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 VICTOR ST
SAINT LOUIS MO
63104-4324
US

IV. Provider business mailing address

1110 VICTOR ST
SAINT LOUIS MO
63104-4324
US

V. Phone/Fax

Practice location:
  • Phone: 314-865-2799
  • Fax: 314-773-8849
Mailing address:
  • Phone: 314-865-2799
  • Fax: 314-773-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2023038663
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: