Provider Demographics
NPI:1952090714
Name:KOCANJER, HARLEY
Entity Type:Individual
Prefix:
First Name:HARLEY
Middle Name:
Last Name:KOCANJER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3299 E SOUTH RANGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44443-9726
Mailing Address - Country:US
Mailing Address - Phone:330-314-6969
Mailing Address - Fax:
Practice Address - Street 1:3299 E SOUTH RANGE RD
Practice Address - Street 2:
Practice Address - City:NEW SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:44443-9726
Practice Address - Country:US
Practice Address - Phone:330-314-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health