Provider Demographics
NPI:1871250738
Name:POLASEK, JACLYN
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:POLASEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LOCUS ST
Mailing Address - Street 2:SUITE 331
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820
Mailing Address - Country:US
Mailing Address - Phone:781-475-9929
Mailing Address - Fax:
Practice Address - Street 1:61 LOCUS ST
Practice Address - Street 2:SUITE 331
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:781-475-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3890224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant