MEDICARE: MRS. JEANNE POLO 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	OT-000477	OH

General Provider Information

NPI Number	:	1578732160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNE POLO OTR/L

Provider Business Mailing Address
First Line	:	11833 WESTON PT
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44149-9275
Country	:	US
Telephone Number	:	440-223-1284
Fax Number	:

Provider Business Practice Location Address
First Line	:	23611 CHAGRIN BLVD
Second Line	:	SUITE 130
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5540
Country	:	US
Telephone Number	:	216-464-0443
Fax Number	:	216-464-0537

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

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	02/27/2008

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