Provider Demographics
NPI:1639709694
Name:POLLARD, MAKENZIE JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:JO
Last Name:POLLARD
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 1:338 E ROSEDALE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47874-7200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:423 4TH ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1126
Practice Address - Country:US
Practice Address - Phone:765-231-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007070A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist