Individual
MS. JEANNA SUZANNE POLONCHEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.D, ATC, CPED, OT-
Contact information
Practice address
1 RECOVERY RD, SUITE FOUR, WAREHAM, MA 02571-5011
(508) 295-8800
(508) 295-9467
Mailing address
707 CRANE AVE S, TAUNTON, MA 02780-7232
(508) 295-5100
(508) 295-9467
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
248
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5788400001
PTAN
MA
Enumeration date
03/24/2006
Last updated
09/08/2009
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