Healthcare Provider Details

I. General information

NPI: 1730742453
Provider Name (Legal Business Name): EMILY VERONICA POLOVICK MOULDS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY VERONICA POLOVICK

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7737 MEANY AVE STE B5
BAKERSFIELD CA
93308-5267
US

IV. Provider business mailing address

3400 CALLOWAY DR STE 603
BAKERSFIELD CA
93312-2514
US

V. Phone/Fax

Practice location:
  • Phone: 661-377-1700
  • Fax:
Mailing address:
  • Phone: 661-377-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: