Individual
TARA POLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1074926
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161216796
22 RESPIRATORY, DEVELOPMENTAL, REHABILITATIVE AND RESTORATIVE SERVICE PROVIDERS
OR
01
—
22
22 RESPIRATORY, DEVELOPMENTAL, REHABILITATIVE AND RESTORATIVE SERVICE PROVIDERS
CA
Enumeration date
08/05/2014
Last updated
08/05/2014
Update your record
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