Healthcare Provider Details

I. General information

NPI: 1245064187
Provider Name (Legal Business Name): SYDNEY KATHRYN BAER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E MAIN ST STE 200
WYTHEVILLE VA
24382-3322
US

IV. Provider business mailing address

569 CEDAR SPRINGS RD
SUGAR GROVE VA
24375-3188
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-6043
  • Fax:
Mailing address:
  • Phone: 404-821-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119010611
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: