Provider Demographics
NPI:1851627616
Name:BRYAN L. CASEY, LLC
Entity Type:Organization
Organization Name:BRYAN L. CASEY, LLC
Other - Org Name:DAYBREAK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:740-350-9095
Mailing Address - Street 1:3546 DUNFEE RD
Mailing Address - Street 2:
Mailing Address - City:COOLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45723-9722
Mailing Address - Country:US
Mailing Address - Phone:740-350-9095
Mailing Address - Fax:201-661-2846
Practice Address - Street 1:31054 SR 93
Practice Address - Street 2:
Practice Address - City:MCARTHUR
Practice Address - State:OH
Practice Address - Zip Code:45651
Practice Address - Country:US
Practice Address - Phone:740-596-5955
Practice Address - Fax:201-661-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPASSPORT252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency