Healthcare Provider Details

I. General information

NPI: 1275933806
Provider Name (Legal Business Name): MICHAEL COLDIRON OTD, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BOGLE ST STE 206
SOMERSET KY
42503-2850
US

IV. Provider business mailing address

401 BOGLE ST STE 206
SOMERSET KY
42503-2850
US

V. Phone/Fax

Practice location:
  • Phone: 859-398-8234
  • Fax: 606-398-8235
Mailing address:
  • Phone: 606-398-8234
  • Fax: 606-398-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberR5688
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR5688
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: