Individual
SHANNON POLIVKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
11 DAIRY LN, FREDERICKSBURG, VA 22405-2663
(540) 371-9414
Mailing address
623 FORBES ST, FREDERICKSBURG, VA 22405-2021
(540) 419-8695
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131002318
VA
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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