Provider Demographics
NPI:1871052373
Name:KACEROVSKIS, ALEXA (OTR)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:KACEROVSKIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11308 BROOK CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7554
Mailing Address - Country:US
Mailing Address - Phone:708-504-8986
Mailing Address - Fax:
Practice Address - Street 1:11308 BROOK CROSSING CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-7554
Practice Address - Country:US
Practice Address - Phone:708-504-8986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist