Provider Demographics
NPI:1861083461
Name:CEKALA, KAROLINA
Entity type:Individual
Prefix:
First Name:KAROLINA
Middle Name:
Last Name:CEKALA
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 1:13555 EAGLE RIDGE DR APT 936
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-6800
Mailing Address - Country:US
Mailing Address - Phone:860-990-0503
Mailing Address - Fax:
Practice Address - Street 1:13555 EAGLE RIDGE DR APT 936
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-6800
Practice Address - Country:US
Practice Address - Phone:860-990-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17933224Z00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant