Provider Demographics
NPI:1275933806
Name:COLDIRON, MICHAEL (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:COLDIRON
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BOGLE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2850
Mailing Address - Country:US
Mailing Address - Phone:606-398-8234
Mailing Address - Fax:606-398-8235
Practice Address - Street 1:401 BOGLE ST STE 206
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2850
Practice Address - Country:US
Practice Address - Phone:859-398-8234
Practice Address - Fax:606-398-8235
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5688225XP0200X
R5688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty