Active NPI
Theresa M Polefko, OT
- Occupational Therapist
- Vermillion, OH
National Provider Identifier
1922069236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT005904
- Practice address
- 1605 St RT 60
Suite 3
Vermillion, OH 44089 - Phone
- (440) 967-2508
- Fax
- (440) 967-4023
- NPI assigned
- Mar 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT005904 | OH | Primary |
Addresses
Primary practice location
1605 St RT 60
Suite 3
Vermillion, OH 44089
Mailing address
1605 St RT 60
Suite 3
Vermillion, OH 44089
Phone (440) 967-2508
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000359898 | Other | OH | ANTHEM BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT005904 | OH | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Transition Healthcare Associates Inc | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Vermillion, OH
- NPI 1851369250
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188259200000",
"number": "1922069236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1605 ST RT 60",
"address_2": "SUITE 3",
"city": "VERMILLION",
"state": "OH",
"postal_code": "44089",
"telephone_number": "440-967-2508",
"fax_number": "440-967-4023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1605 ST RT 60",
"address_2": "SUITE 3",
"city": "VERMILLION",
"state": "OH",
"postal_code": "44089",
"telephone_number": "440-967-2508",
"fax_number": "440-967-4023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLEFKO",
"first_name": "THERESA",
"middle_name": "M",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-28",
"last_updated": "2007-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OH",
"license": "OT005904",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS",
"identifier": "000000359898",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vermillion, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.