Provider Demographics
NPI:1760648042
Name:SYKES, LISA AJ (OTR)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:AJ
Last Name:SYKES
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 1:6 JOMANDA WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9186
Mailing Address - Country:US
Mailing Address - Phone:585-748-0998
Mailing Address - Fax:
Practice Address - Street 1:6 JOMANDA WAY
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9186
Practice Address - Country:US
Practice Address - Phone:585-748-0998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004064-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist