Provider Demographics
NPI:1912745670
Name:STAHL, SYDNEY LEANNE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LEANNE
Last Name:STAHL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 ALLEN CT
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-3025
Mailing Address - Country:US
Mailing Address - Phone:952-688-3012
Mailing Address - Fax:
Practice Address - Street 1:911 BRYANT ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2711
Practice Address - Country:US
Practice Address - Phone:650-327-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225X00000X
OR512674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist