Provider Demographics
NPI:1285933374
Name:SICA, RICHARD G (OTR)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:SICA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:491 EISENHOWER CT
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2205
Mailing Address - Country:US
Mailing Address - Phone:201-847-0881
Mailing Address - Fax:201-493-7445
Practice Address - Street 1:168 FRANKLIN TPKE
Practice Address - Street 2:STE 103B
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1848
Practice Address - Country:US
Practice Address - Phone:201-493-7440
Practice Address - Fax:201-493-7445
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00542100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist