Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OC010962 | PA |
N | 225XG0600X | Occupational Therapist - Gerontology | OC010962 | PA |
N | 225XH1200X | Occupational Therapist - Hand | OC010962 | PA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OC010962 | PA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC010962 | PA |
NPI | 1649812686 |
---|---|
Provider Name | Marianne Polyakov |
First Address | Jamison, PA 18929-1772 |
Second Address | Jamison, PA 18929-1772 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2019 |
Last Update Date | 10/10/2019 |