Individual
MR. MICHAEL A KOLONICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTAL
Contact information
Practice address
575 S CLEVELAND MASSILLON RD, FAIRLAWN, OH 44333-3019
(330) 666-5866
Mailing address
145 HUNT CLUB DR, APT 3C, COPLEY, OH 44321-2912
(330) 603-4679
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA01765
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0139424
—
OH
Enumeration date
07/02/2007
Last updated
07/08/2007
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