Individual
BRENDA KAY POLSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S., O.T.
Contact information
Practice address
744 E 3RD ST, BLOOMINGTON, IN 47405-3603
(812) 855-8436
(812) 855-1683
Mailing address
744 E 3RD ST, BLOOMINGTON, IN 47405-3603
(812) 855-8436
(812) 855-1683
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
31002137A
IN
225XL0004X
Low Vision Occupational Therapist
Primary
31002137A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000584866
ANTHEM
IN
05
—
200854470
—
IN
Enumeration date
11/30/2006
Last updated
01/22/2019
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