Individual
MICHELLE A POLVINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS;ED.
Contact information
Practice address
4229 OSBORNE RD, FREDONIA, NY 14063-9527
(716) 673-5423
Mailing address
4229 OSBORNE RD, FREDONIA, NY 14063-9527
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
184317871
NY
Other
Enumeration date
07/23/2010
Last updated
07/23/2010
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