Provider Demographics
NPI:1871270397
Name:POLEN, DONNA W (LCAT, MT-BC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:W
Last Name:POLEN
Suffix:
Gender:F
Credentials:LCAT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9749
Mailing Address - Country:US
Mailing Address - Phone:585-455-8381
Mailing Address - Fax:
Practice Address - Street 1:67 WATERFORD WAY
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9749
Practice Address - Country:US
Practice Address - Phone:585-455-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist