Healthcare Provider Details

I. General information

NPI: 1881131670
Provider Name (Legal Business Name): ELISE SIAK-FITCH MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISE SIAK MS OTR/L

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 FURNACE AVE
GLEN BURNIE MD
21060-7002
US

IV. Provider business mailing address

5983 AUGUSTINE AVE
ELKRIDGE MD
21075-5318
US

V. Phone/Fax

Practice location:
  • Phone: 443-685-4979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number07846
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: