Provider Demographics
NPI:1710758131
Name:BRADY, MARK PAYSON
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PAYSON
Last Name:BRADY
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 1:3701 TOWNSHIP ROAD 75
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-9606
Mailing Address - Country:US
Mailing Address - Phone:614-312-7252
Mailing Address - Fax:
Practice Address - Street 1:3701 TOWNSHIP ROAD 75
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-9606
Practice Address - Country:US
Practice Address - Phone:614-312-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services