Provider Demographics
NPI:1811328073
Name:GRISWOLD, ERIKA G (MS)
Entity type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:G
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:ERIKA
Other - Middle Name:G
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:12276 SAN JOSE BLVD STE 508
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8618
Mailing Address - Country:US
Mailing Address - Phone:904-886-3228
Mailing Address - Fax:904-485-8876
Practice Address - Street 1:12276 SAN JOSE BLVD STE 508
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8618
Practice Address - Country:US
Practice Address - Phone:904-886-3228
Practice Address - Fax:904-485-8876
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24580225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist