Provider Demographics
NPI:1538454954
Name:SIKES, ELIZABETH M (PHD, OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:SIKES
Suffix:
Gender:F
Credentials:PHD, OTR/L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46782 GRAHAM COVE SQ
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7536
Mailing Address - Country:US
Mailing Address - Phone:910-545-3397
Mailing Address - Fax:
Practice Address - Street 1:46782 GRAHAM COVE SQ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7536
Practice Address - Country:US
Practice Address - Phone:910-545-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 16832225X00000X
222Q00000X
VA0119008521225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist