Individual
ALYSON POLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
60 BRIMLEY DR, FREDERICKSBURG, VA 22406-5148
(540) 552-6262
Mailing address
2200 GAUSE BLVD E, SLIDELL, LA 70461-4223
(985) 781-4545
(317) 449-5783
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
006809
OH
225X00000X
Occupational Therapist
0119006721
VA
Other
Enumeration date
09/26/2007
Last updated
01/28/2021
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