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NPI Code Detail

MEDICARE: SYDNEY RADCLIFF MOT, OTR/L

MEDICARE: SYDNEY RADCLIFF MOT, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist056.012378IL

General Provider Information

NPI Number : 1124528278
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYDNEY RADCLIFF MOT, OTR/L
Provider Business Mailing Address
First Line : 1641 N MAPLEWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-5211
Country : US
Telephone Number : 502-471-8388
Fax Number :
Provider Business Practice Location Address
First Line : 11053 S MILLARD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-3327
Country : US
Telephone Number : 502-471-8388
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2018
Last Update Date : 02/15/2018

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Directions to “ SYDNEY RADCLIFF MOT, OTR/L” Practice Location

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