Provider Demographics
NPI:1801008503
Name:FLETCHER, POLLY (OTR)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WHITTIER PL
Mailing Address - Street 2:SUITE 16 H
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1443
Mailing Address - Country:US
Mailing Address - Phone:617-670-1963
Mailing Address - Fax:
Practice Address - Street 1:6 WHITTIER PL
Practice Address - Street 2:SUITE 16 H
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1443
Practice Address - Country:US
Practice Address - Phone:617-670-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3631171W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171W00000XOther Service ProvidersContractor
Not Answered174400000XOther Service ProvidersSpecialist