Healthcare Provider Details

I. General information

NPI: 1972077329
Provider Name (Legal Business Name): MOLLY KATHLEEN ZOLCAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 RICHLAND AVE
ATHENS OH
45701-2745
US

IV. Provider business mailing address

9155 JACKSON ST
MENTOR OH
44060-4474
US

V. Phone/Fax

Practice location:
  • Phone: 440-487-6683
  • Fax:
Mailing address:
  • Phone: 440-487-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: