Healthcare Provider Details

I. General information

NPI: 1871458356
Provider Name (Legal Business Name): AMBER R ULICKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N14W23800 STONE RIDGE DR STE 110
WAUKESHA WI
53188-1144
US

IV. Provider business mailing address

N55W17862 HIGH BLUFF DR UNIT D
MENOMONEE FALLS WI
53051-1276
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-8830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9064-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: