Healthcare Provider Details

I. General information

NPI: 1598255812
Provider Name (Legal Business Name): MRS. ELISA CAROLYN GRIEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 ARTHUR BLVD
MERRILLVILLE IN
46410-3766
US

IV. Provider business mailing address

9051 W 1550 S
WANATAH IN
46390-9619
US

V. Phone/Fax

Practice location:
  • Phone: 219-931-4184
  • Fax:
Mailing address:
  • Phone: 219-241-8816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32000972A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: