Provider Demographics
NPI:1851955512
Name:POLHEMUS, AUGUSTA HIXON (OTR/L)
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:HIXON
Last Name:POLHEMUS
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 1:58 RUTLAND ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1526
Mailing Address - Country:US
Mailing Address - Phone:617-306-1123
Mailing Address - Fax:
Practice Address - Street 1:35 FOREST RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3844
Practice Address - Country:US
Practice Address - Phone:978-287-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty