Provider Demographics
NPI:1750536199
Name:POLANSKI KOERBER, LILY ERVIN (OT)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:ERVIN
Last Name:POLANSKI KOERBER
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 1:1110 HENDERSONVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:PISGAH FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:28768-9238
Mailing Address - Country:US
Mailing Address - Phone:828-712-8476
Mailing Address - Fax:
Practice Address - Street 1:1110 HENDERSONVILLE HWY
Practice Address - Street 2:
Practice Address - City:PISGAH FOREST
Practice Address - State:NC
Practice Address - Zip Code:28768-9238
Practice Address - Country:US
Practice Address - Phone:828-712-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY780225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist