Healthcare Provider Details

I. General information

NPI: 1811747173
Provider Name (Legal Business Name): ERICA TAYLER GRIESBAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S77W12929 MCSHANE DR
MUSKEGO WI
53150-4099
US

IV. Provider business mailing address

12540 DUNCAN LN UNIT 104
NEW BERLIN WI
53151-8760
US

V. Phone/Fax

Practice location:
  • Phone: 414-529-0100
  • Fax:
Mailing address:
  • Phone: 630-995-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: