Provider Demographics
NPI:1730577826
Name:GAGGIANI, BRANDY LYN (MS/AT)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYN
Last Name:GAGGIANI
Suffix:
Gender:F
Credentials:MS/AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 PEASE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3264
Mailing Address - Country:US
Mailing Address - Phone:440-343-4775
Mailing Address - Fax:
Practice Address - Street 1:2733 PEASE DR
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3264
Practice Address - Country:US
Practice Address - Phone:440-343-4775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-18642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer