Provider Demographics
NPI:1508011990
Name:CLAY, BRANDY J (LMT)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:J
Last Name:CLAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 N SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1030
Mailing Address - Country:US
Mailing Address - Phone:419-294-9490
Mailing Address - Fax:419-294-2946
Practice Address - Street 1:106 E FINDLAY ST
Practice Address - Street 2:
Practice Address - City:CAREY
Practice Address - State:OH
Practice Address - Zip Code:43316-1248
Practice Address - Country:US
Practice Address - Phone:419-396-1515
Practice Address - Fax:419-396-1919
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$-00OtherBWC