Jacqueline Lee Polakowski, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

83027 Issued in WI

Practice address

3821 S Chicago Ave
South Milwaukee, WI 53172-3712

Phone

(414) 762-6379

NPI assigned

May 2, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1215159348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 OAK ST",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721455",
            "telephone_number": "414-762-6379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3821 S CHICAGO AVE",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531723712",
            "telephone_number": "414-762-6379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLAKOWSKI",
        "first_name": "JACQUELINE",
        "middle_name": "LEE",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WI",
            "license": "83027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40599000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• PDN
• Anna Michelle Pearson
• David J Pencikowski, NP
• Steven Christopher Penn
• Larry John Pleva, P.T.
• Potisk Chiropractic Office, S.C.
• Thomas Potisk, DC
• Lesa Povletich, RN
• Premier Care of Wisconsin, LLC.
• Premier Care of Wisconsin, LLC.

• Occupational Therapy Assistant in South Milwaukee, WI
• Providers in South Milwaukee, WI by specialty
• Occupational Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.