MEDICARE: MS. HOLLIE ANN KOZAK ATC, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT-300	OH

General Provider Information

NPI Number	:	1215909924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLIE ANN KOZAK ATC, LAT

Provider Business Mailing Address
First Line	:	27190 ORIOLE AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-1507
Country	:	US
Telephone Number	:	216-731-6868
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 N MAIN ST
Second Line	:	MAIN 3
City	:	AKRON
State	:	OH
Zip	:	44310-3110
Country	:	US
Telephone Number	:	330-379-5356
Fax Number	:	330-379-5911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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