Healthcare Provider Details

I. General information

NPI: 1417306721
Provider Name (Legal Business Name): SYDNEY FAIR OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY BOYCE OT

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 WILCO RD
STAYTON OR
97383
US

IV. Provider business mailing address

2675 NE LANCASTER ST APT 76
CORVALLIS OR
97330-4144
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-7131
  • Fax: 503-769-7132
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number337582
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: