Individual
JACQUELINE LEE POLAKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3821 S CHICAGO AVE, SOUTH MILWAUKEE, WI 53172-3712
(414) 762-6379
Mailing address
1717 OAK ST, SOUTH MILWAUKEE, WI 53172-1455
(414) 762-6379
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
83027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40599000
—
WI
Enumeration date
05/02/2007
Last updated
07/09/2007
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