Healthcare Provider Details

I. General information

NPI: 1215909924
Provider Name (Legal Business Name): HOLLIE ANN KOZAK ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MAIN ST MAIN 3
AKRON OH
44310-3110
US

IV. Provider business mailing address

27190 ORIOLE AVE
EUCLID OH
44132-1507
US

V. Phone/Fax

Practice location:
  • Phone: 330-379-5356
  • Fax: 330-379-5911
Mailing address:
  • Phone: 216-731-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-300
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: