Individual
MICHAEL COLACICCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17119 CEDAR DR, EDMOND, OK 73012-6888
(908) 642-7957
Mailing address
17119 CEDAR DR, EDMOND, OK 73012-6888
(908) 642-7957
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
613
OK
390200000X
Student in an Organized Health Care Education/Training Program
613
OK
Other
Enumeration date
04/08/2015
Last updated
04/08/2015
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