Provider Demographics
NPI:1952979213
Name:KUCHERUK, EMILEE (COTA/L)
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:
Last Name:KUCHERUK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SENECA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-1360
Mailing Address - Country:US
Mailing Address - Phone:703-943-0398
Mailing Address - Fax:
Practice Address - Street 1:4900 MASSACHUSETTS AVE NW STE 340
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4358
Practice Address - Country:US
Practice Address - Phone:202-621-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002253224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty