MEDICARE: MONICA ISABEL POLANCO

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	10455	MD

General Provider Information

NPI Number	:	1760280820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA ISABEL POLANCO

Provider Business Mailing Address
First Line	:	5908 66TH AVE
Second Line	:
City	:	RIVERDALE
State	:	MD
Zip	:	20737-1716
Country	:	US
Telephone Number	:	301-943-7758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 CROFTON BLVD STE 103
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-1342
Country	:	US
Telephone Number	:	410-451-5700
Fax Number	:	410-451-5703

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

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	03/05/2025

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Directions to “ MONICA ISABEL POLANCO ” Practice Location

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