Provider Demographics
NPI:1538748678
Name:AUSTIN, RICHARD BRANDON
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRANDON
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 SANDSTONE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1085
Mailing Address - Country:US
Mailing Address - Phone:216-822-3039
Mailing Address - Fax:
Practice Address - Street 1:266 SANDSTONE RIDGE WAY
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1085
Practice Address - Country:US
Practice Address - Phone:216-822-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X, 251B00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No251B00000XAgenciesCase Management