Provider Demographics
NPI:1083283675
Name:VIATOR, BRANDON
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:VIATOR
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:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:STOLLINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25646-0274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 PERSIMMON HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:STOLLINGS
Practice Address - State:WV
Practice Address - Zip Code:25646-0274
Practice Address - Country:US
Practice Address - Phone:337-967-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child