Provider Demographics
NPI:1023428000
Name:KOTNIK, KATHLEEN MARIE (MED)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:KOTNIK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:2155 MIRAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3301
Mailing Address - Country:US
Mailing Address - Phone:216-320-5031
Mailing Address - Fax:
Practice Address - Street 1:2155 MIRAMAR BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3301
Practice Address - Country:US
Practice Address - Phone:216-320-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
OHNY1006636103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant