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Individual

THERESA M POLEFKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
1605 ST RT 60, SUITE 3, VERMILLION, OH 44089
(440) 967-2508
(440) 967-4023
Mailing address
1605 ST RT 60, SUITE 3, VERMILLION, OH 44089
(440) 967-2508
(440) 967-4023

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005904
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000359898
ANTHEM BLUE CROSS
OH
Enumeration date
03/28/2006
Last updated
08/28/2007
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