Michael Colacicco

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

613 Issued in OK

Practice address

17119 Cedar Dr
Edmond, OK 73012-6888

Phone

(908) 642-7957

NPI assigned

Apr 8, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428451200000",
    "number": "1831585736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17119 CEDAR DR",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730126888",
            "telephone_number": "908-642-7957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17119 CEDAR DR",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730126888",
            "telephone_number": "908-642-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLACICCO",
        "first_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-08",
        "last_updated": "2015-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OK",
            "license": "613",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OK",
            "license": "613",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Dakota Coffey, BACHELORS DEGREE
• Zachary Terrell Coffey, BA IN SOCIOLOGY
• Cognitive Transformations
• Lawrence J Cohen, PHARMD, BCPP
• Cohesive Mediryde
• Elaine Marie Cole
• Jeremy Cole, MD
• Omari Cole
• Lauren Coleman, PT, DPT
• Micaela Coleman, MD

• Athletic Trainer in Edmond, OK
• Providers in Edmond, OK by specialty
• Athletic Trainer in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.