Provider Demographics
NPI:1952643538
Name:SUSTERKA, CATHERINE A
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:A
Last Name:SUSTERKA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:A
Other - Last Name:SCHMECKPEPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8327 FAME AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147
Mailing Address - Country:US
Mailing Address - Phone:702-813-5186
Mailing Address - Fax:
Practice Address - Street 1:8327 FAME AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147
Practice Address - Country:US
Practice Address - Phone:702-813-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225400000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner