=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881221059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERINN GRETA BRATLEY MA, OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2020
-----------------------------------------------------
Last Update Date | 03/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11040 N STATE ROAD 77
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54843-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-934-4234
-----------------------------------------------------
Fax | 715-934-5416
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11040 N STATE ROAD 77
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54843-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-934-4234
-----------------------------------------------------
Fax | 715-934-5416
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 3272-26
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------