Provider Demographics
NPI:1962587410
Name:SORKER, SIDHARTHA (OTR/L)
Entity type:Individual
Prefix:MR
First Name:SIDHARTHA
Middle Name:
Last Name:SORKER
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:SID
Other - Middle Name:
Other - Last Name:SORKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:93 BENT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2172
Mailing Address - Country:US
Mailing Address - Phone:731-441-2359
Mailing Address - Fax:731-256-0667
Practice Address - Street 1:33 DIRECTORS ROW
Practice Address - Street 2:MEDICAL CENTER HOME HEALTH
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2316
Practice Address - Country:US
Practice Address - Phone:800-748-3025
Practice Address - Fax:731-984-2079
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist