Individual
MRS. LISA POLHEBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3400 E RACINE ST, JANESVILLE, WI 53546-2344
(608) 373-8353
Mailing address
4070 GREENBRIAR DR, JANESVILLE, WI 53546-4445
(262) 894-4115
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1843-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40862300
—
WI
Enumeration date
03/13/2007
Last updated
12/20/2011
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