Provider Demographics
NPI:1013754597
Name:KOEPPEN, SYDNEY J (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:J
Last Name:KOEPPEN
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 1:2863 HUNT TRL
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-7993
Mailing Address - Country:US
Mailing Address - Phone:319-202-8920
Mailing Address - Fax:
Practice Address - Street 1:620 WILCOX ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1739
Practice Address - Country:US
Practice Address - Phone:319-202-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist