Provider Demographics
NPI:1467658054
Name:KUCEROVA, KATERINA (MSOT, CLT)
Entity type:Individual
Prefix:MS
First Name:KATERINA
Middle Name:
Last Name:KUCEROVA
Suffix:
Gender:F
Credentials:MSOT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WESTCOTT RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3062
Mailing Address - Country:US
Mailing Address - Phone:917-698-2118
Mailing Address - Fax:
Practice Address - Street 1:130 WESTCOTT RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3062
Practice Address - Country:US
Practice Address - Phone:917-698-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012996-1225X00000X
NJ46TR00713100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist