Provider Demographics
NPI:1336941780
Name:JOHNSON, SYDNEY CLAIRE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:CLAIRE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAINSAIL DR
Mailing Address - Street 2:
Mailing Address - City:THIRD LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2604
Mailing Address - Country:US
Mailing Address - Phone:630-352-9610
Mailing Address - Fax:
Practice Address - Street 1:400 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5254
Practice Address - Country:US
Practice Address - Phone:919-424-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25864225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist