Provider Demographics
NPI:1497192603
Name:DRAPER, BRETT ANTHONY (MED AT,C)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ANTHONY
Last Name:DRAPER
Suffix:
Gender:M
Credentials:MED AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PATRICK JOHN DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8248
Mailing Address - Country:US
Mailing Address - Phone:330-571-4122
Mailing Address - Fax:
Practice Address - Street 1:373 CARROLL ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44325-0019
Practice Address - Country:US
Practice Address - Phone:330-972-6058
Practice Address - Fax:330-972-5253
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8604892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer