Provider Demographics
NPI:1154445336
Name:SYKIMTE, MICHELLE PATINO (OTR)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:PATINO
Last Name:SYKIMTE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11720 STIDHAM RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-7641
Mailing Address - Country:US
Mailing Address - Phone:281-799-9249
Mailing Address - Fax:
Practice Address - Street 1:1999 LAKE OF WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3189
Practice Address - Country:US
Practice Address - Phone:971-206-9786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1959225X00000X
TX112346225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156119721Medicaid