Provider Demographics
NPI:1730742453
Name:POLOVICK MOULDS, EMILY VERONICA (OTR)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:VERONICA
Last Name:POLOVICK MOULDS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:VERONICA
Other - Last Name:POLOVICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 CALLOWAY DR STE 603
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2514
Mailing Address - Country:US
Mailing Address - Phone:661-377-1700
Mailing Address - Fax:
Practice Address - Street 1:7737 MEANY AVE STE B5
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5267
Practice Address - Country:US
Practice Address - Phone:661-377-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist