Provider Demographics
NPI:1053719195
Name:POLLAK, JUDI (MSOTR/L)
Entity type:Individual
Prefix:
First Name:JUDI
Middle Name:
Last Name:POLLAK
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 HAGEWA DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6240
Mailing Address - Country:US
Mailing Address - Phone:513-686-1780
Mailing Address - Fax:513-791-4873
Practice Address - Street 1:5959 HAGEWA DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6240
Practice Address - Country:US
Practice Address - Phone:513-686-1780
Practice Address - Fax:513-791-4873
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist