Individual
MRS. TIFFANY RAE POLETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1104 WESLEY AVE, BRYAN, OH 43506-2579
(419) 636-5071
Mailing address
1104 WESLEY AVE, BRYAN, OH 43506-2579
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.03818
OH
Other
Enumeration date
11/26/2012
Last updated
11/26/2012
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