Healthcare Provider Details

I. General information

NPI: 1780310573
Provider Name (Legal Business Name): SYDNEY FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 WEST ST
CAREY OH
43316-1415
US

IV. Provider business mailing address

328 WEST ST
CAREY OH
43316-1415
US

V. Phone/Fax

Practice location:
  • Phone: 419-722-4354
  • Fax:
Mailing address:
  • Phone: 419-722-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: