MEDICARE: TATIANA KUTERGINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	021393	NY

General Provider Information

NPI Number	:	1538693163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA KUTERGINA

Provider Business Mailing Address
First Line	:	6717 FORT HAMILTON PKWY APT C5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5854
Country	:	US
Telephone Number	:	646-420-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	6717 FORT HAMILTON PKWY APT C5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5854
Country	:	US
Telephone Number	:	646-420-0909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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Directions to “ TATIANA KUTERGINA ” Practice Location

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