MEDICARE: JENNIFER MARLENE POLAND OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	8878	MA

General Provider Information

NPI Number	:	1902444961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARLENE POLAND OTR/L

Provider Business Mailing Address
First Line	:	183 KIRK TER
Second Line	:
City	:	NORTH DIGHTON
State	:	MA
Zip	:	02764-1107
Country	:	US
Telephone Number	:	401-862-6291
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 FORBES RD
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-2706
Country	:	US
Telephone Number	:	781-356-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2019
Last Update Date	:	12/20/2019

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