Active NPI
Michelle Renee Sydnor, OTR/L, CHT
- Occupational Therapist
- Raleigh, NC
National Provider Identifier
1790755619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0803
- Practice address
- 2418 Blue Ridge Rd
Suite 100
Raleigh, NC 27607-6480 - Phone
- (919) 782-5954
- Fax
- (919) 859-9444
- NPI assigned
- Jan 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 0803 | NC | Primary |
Addresses
Primary practice location
2418 Blue Ridge Rd
Suite 100
Raleigh, NC 27607-6480
Mailing address
3528 Wade Avenue
#139
Raleigh, NC 27607-4048
Phone (919) 782-5954
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5947795 | Other | NC | AETNA |
| D9649 | Other | NC | MEDCOST |
| 670002182 | Other | NC | MEDICARE RAILROAD |
| 81309 | Other | NC | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 803 | NC | MD | Specialist |
| 0803 | NC | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellness One, Inc | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212105600000",
"number": "1790755619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3528 WADE AVENUE",
"address_2": "#139",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276074048",
"telephone_number": "919-782-5954",
"fax_number": "919-859-9444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2418 BLUE RIDGE RD",
"address_2": "SUITE 100",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276076480",
"telephone_number": "919-782-5954",
"fax_number": "919-859-9444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SYDNOR",
"first_name": "MICHELLE",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "OTR/L, CHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-24",
"last_updated": "2008-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "0803",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5947795",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "D9649",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "670002182",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "81309",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.