MEDICARE: DR. HAYLEY ERICKSEN PHD, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	2046-39	WI

General Provider Information

NPI Number	:	1801390448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAYLEY ERICKSEN PHD, ATC

Provider Business Mailing Address
First Line	:	3409 N DOWNER AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211
Country	:	US
Telephone Number	:	414-229-5761
Fax Number	:

Provider Business Practice Location Address
First Line	:	3409 N DOWNER AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211
Country	:	US
Telephone Number	:	414-229-5761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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