Active NPI
Tara Polanco
- Occupational Therapist
- Tigard, OR
National Provider Identifier
1922417724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1074926
- Practice address
- 7320 SW Hunziker St
Tigard, OR 97223-8283 - Phone
- (888) 317-1019
- NPI assigned
- Aug 5, 2014
- 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 | 1074926 | OR | Primary |
Addresses
Primary practice location
7320 SW Hunziker St
Tigard, OR 97223-8283
Mailing address
227 Andover St
San Francisco, CA 94110-5609
Phone (415) 425-1026
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 161216796 | Other | OR | 22 RESPIRATORY, DEVELOPMENTAL, REHABILITATIVE AND RESTORATIVE SERVICE PROVIDERS |
| 22 | Other | CA | 22 RESPIRATORY, DEVELOPMENTAL, REHABILITATIVE AND RESTORATIVE SERVICE PROVIDERS |
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 |
|---|---|---|---|
| 1074926 | OR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407196800000",
"number": "1922417724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "227 ANDOVER ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941105609",
"telephone_number": "415-425-1026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7320 SW HUNZIKER ST",
"city": "TIGARD",
"state": "OR",
"postal_code": "972238283",
"telephone_number": "888-317-1019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLANCO",
"first_name": "TARA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-05",
"last_updated": "2014-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OR",
"license": "1074926",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "22 RESPIRATORY, DEVELOPMENTAL, REHABILITATIVE AND RESTORATIVE SERVICE PROVIDERS",
"identifier": "161216796",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "22 RESPIRATORY, DEVELOPMENTAL, REHABILITATIVE AND RESTORATIVE SERVICE PROVIDERS",
"identifier": "22",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.