Provider Demographics
NPI:1578732160
Name:POLO, JEANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:
Last Name:POLO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11833 WESTON PT
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-9275
Mailing Address - Country:US
Mailing Address - Phone:440-223-1284
Mailing Address - Fax:
Practice Address - Street 1:23611 CHAGRIN BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5540
Practice Address - Country:US
Practice Address - Phone:216-464-0443
Practice Address - Fax:216-464-0537
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-000477225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist