Provider Demographics
NPI:1881131670
Name:SIAK-FITCH, ELISE (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:
Last Name:SIAK-FITCH
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:SIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:6249 SANDPIPER CT # 9
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12520 PROSPERITY DR STE 210
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1684
Practice Address - Country:US
Practice Address - Phone:301-869-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07846225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist