Provider Demographics
NPI:1154404184
Name:POLSTON, KATHLEEN FAITH (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:FAITH
Last Name:POLSTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SW 34TH CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474
Mailing Address - Country:US
Mailing Address - Phone:352-237-2292
Mailing Address - Fax:352-237-2236
Practice Address - Street 1:3301 SW 34TH CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6621
Practice Address - Country:US
Practice Address - Phone:352-237-2292
Practice Address - Fax:352-237-2236
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM426225X00000X
FL12649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist