Provider Demographics
NPI:1407086630
Name:POLZIN, JESSIE BILITZ (OT)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:BILITZ
Last Name:POLZIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15216 FANNING DR N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-6307
Mailing Address - Country:US
Mailing Address - Phone:651-633-7875
Mailing Address - Fax:
Practice Address - Street 1:825 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6846
Practice Address - Country:US
Practice Address - Phone:651-633-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103758225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist