Provider Demographics
NPI:1801052378
Name:SYLVIA, NANCY REBECCA (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:REBECCA
Last Name:SYLVIA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 1ST ST N
Mailing Address - Street 2:SUITE200
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6945
Mailing Address - Country:US
Mailing Address - Phone:904-241-9231
Mailing Address - Fax:888-794-5038
Practice Address - Street 1:900 KIWANIS DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4580
Practice Address - Country:US
Practice Address - Phone:815-235-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057002996224Z00000X
TNOTA169224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant