Provider Demographics
NPI:1548920119
Name:SIDDONS, SADIE BELLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SADIE
Middle Name:BELLE
Last Name:SIDDONS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17050 N QUALITY LIME RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-4698
Mailing Address - Country:US
Mailing Address - Phone:217-686-4665
Mailing Address - Fax:
Practice Address - Street 1:17050 N QUALITY LIME RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-4698
Practice Address - Country:US
Practice Address - Phone:217-686-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014669225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology