Provider Demographics
NPI:1619483997
Name:SISK, ERIN MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:MARIE
Last Name:SISK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ST GEORGES AVENUE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036
Mailing Address - Country:US
Mailing Address - Phone:908-587-1624
Mailing Address - Fax:
Practice Address - Street 1:210 ST GEORGES AVENUE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036
Practice Address - Country:US
Practice Address - Phone:908-587-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021817225X00000X
NJ46TR00796100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist