Provider Demographics
NPI:1811357379
Name:POLEGA, KAYLE ROSE (MSOT, OTRL)
Entity type:Individual
Prefix:
First Name:KAYLE
Middle Name:ROSE
Last Name:POLEGA
Suffix:
Gender:F
Credentials:MSOT, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 W HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-9710
Mailing Address - Country:US
Mailing Address - Phone:989-892-3591
Mailing Address - Fax:
Practice Address - Street 1:564 W HAMPTON RD
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-9710
Practice Address - Country:US
Practice Address - Phone:989-892-3591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist