Individual
POLLY S CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
288 DEXTER RD APT 104, CLOVER, SC 29710-4136
(304) 479-3210
Mailing address
288 DEXTER RD APT 104, CLOVER, SC 29710-4136
(304) 479-3210
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
13086
NC
225X00000X
Occupational Therapist
OC010299
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017671860001
—
PA
Enumeration date
12/01/2006
Last updated
03/12/2020
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