Provider Demographics
NPI:1417304262
Name:GORECKI, KATHERINE HELEN (MA, ATC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HELEN
Last Name:GORECKI
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 BLUE BELL WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5615
Mailing Address - Country:US
Mailing Address - Phone:270-745-3743
Mailing Address - Fax:270-745-4106
Practice Address - Street 1:1605 AVENUE OF CHAMPIONS
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-6412
Practice Address - Country:US
Practice Address - Phone:270-745-3743
Practice Address - Fax:270-745-4106
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT8082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer