Provider Demographics
NPI:1922481217
Name:STAGANI, TYLER R
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:R
Last Name:STAGANI
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 1:801 COUNTY ROAD 41
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:OH
Mailing Address - Zip Code:43944-6905
Mailing Address - Country:US
Mailing Address - Phone:740-381-3890
Mailing Address - Fax:
Practice Address - Street 1:310 E MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2434
Practice Address - Country:US
Practice Address - Phone:740-381-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-03
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH593351587327OtherMEDICAL MUTUAL