Healthcare Provider Details

I. General information

NPI: 1952620866
Provider Name (Legal Business Name): SHERRY LYNNE POLCYN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 OLD HOWELL RD
GREENVILLE SC
29615-1969
US

IV. Provider business mailing address

11366 DUNDARRACH LN
CHARLOTTE NC
28277-2180
US

V. Phone/Fax

Practice location:
  • Phone: 877-508-3237
  • Fax:
Mailing address:
  • Phone: 704-661-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5331
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: