Basic Information
Provider Information
NPI: 1578909198
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POLLNOW
FirstName: EMILIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: KACZYNSKA
OtherFirstName: EMILIA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 925 CHESTNUT ST
Address2: 5TH FLOOR
City: PHILADELPHIA
State: PA
PostalCode: 191074216
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 925 CHESTNUT ST
Address2: 5TH FLOOR
City: PHILADELPHIA
State: PA
PostalCode: 191074216
CountryCode: US
TelephoneNumber: 2673393500
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/22/2013
LastUpdateDate: 04/09/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOC012832PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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