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General NPI Number Information
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NPI Number | 1972023745
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Entity Type | Individual
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Provider Name | RACHEL MARIE POLLETTA OT
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Gender | Female
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 06/22/2017
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Provider Practice Location Address
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Address Line | 5219 88TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-7468
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Country | US
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Telephone | 126-265-3085
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Fax |
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Provider Business Mailing Address
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Address Line | 1381 W BIRDSONG DR APT A7
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City | OAK CREEK
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State | WI
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Zip | 53154-8424
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Country | US
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Telephone |
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Fax |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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