Individual
STEPHANIE ANNE POLUKOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4910 BEAR VIEW DR, PARK CITY, UT 84098-8553
(435) 640-9001
Mailing address
4910 BEAR VIEW DR, PARK CITY, UT 84098-8553
(435) 640-9001
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4829530-4201
UT
Other
Enumeration date
11/30/2009
Last updated
11/30/2009
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