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General NPI Number Information
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NPI Number | 1790745693
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Entity Type | Individual
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Provider Name | JEANNA SUZANNE POLONCHEK ED.D, ATC, CPED, OT-
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Gender | Female
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 1 RECOVERY RD SUITE FOUR
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City | WAREHAM
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State | MA
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Zip | 02571-5011
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Country | US
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Telephone | 508-295-8800
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Fax | 508-295-9467
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Provider Business Mailing Address
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Address Line | 707 CRANE AVE S
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City | TAUNTON
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State | MA
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Zip | 02780-7232
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Country | US
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Telephone | 508-295-5100
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Fax | 508-295-9467
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 248
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License Number State | MA
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