Basic Information
| Provider Information | |||||||||
| NPI: | 1841344009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIESENAUER | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5570 PEBBLE VILLAGE LN | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460627423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177709223 | ||||||||
| FaxNumber: | 3177709266 | ||||||||
| Practice Location | |||||||||
| Address1: | 5570 PEBBLE VILLAGE LN | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460627423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177709223 | ||||||||
| FaxNumber: | 3177709266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 05/01/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 3100746A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 31003746A | 01 | IN | INDIANA LICENSE NUMBER | OTHER |