Provider Demographics
NPI:1245647684
Name:KATALINICH, MICHAEL (MOTR/L)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:KATALINICH
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 STONYBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-8904
Mailing Address - Country:US
Mailing Address - Phone:419-345-8776
Mailing Address - Fax:
Practice Address - Street 1:3231 MANLEY RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9680
Practice Address - Country:US
Practice Address - Phone:419-865-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-005419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist