Provider Demographics
NPI:1306358114
Name:KATANOV-NEKTALOV, MAZAL (OTR/L)
Entity Type:Individual
Prefix:
First Name:MAZAL
Middle Name:
Last Name:KATANOV-NEKTALOV
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 99TH ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3570
Mailing Address - Country:US
Mailing Address - Phone:646-577-8008
Mailing Address - Fax:
Practice Address - Street 1:65-09 99TH ST
Practice Address - Street 2:APT.1T
Practice Address - City:REGO PARK QUEENS,NY
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:164-577-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021792225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty