Healthcare Provider Details

I. General information

NPI: 1538998703
Provider Name (Legal Business Name): MICHELLE SICA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N DUPONT HWY
NEW CASTLE DE
19720-1100
US

IV. Provider business mailing address

139 WESLEY ST
ELKTON MD
21921-5456
US

V. Phone/Fax

Practice location:
  • Phone: 302-255-2700
  • Fax:
Mailing address:
  • Phone: 443-790-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License NumberU1-0012479
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: