Provider Demographics
NPI:1972962157
Name:GEISER, BRANDON
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:GEISER
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 1:17042 COUNTY ROAD 12
Mailing Address - Street 2:
Mailing Address - City:PIONEER
Mailing Address - State:OH
Mailing Address - Zip Code:43554
Mailing Address - Country:US
Mailing Address - Phone:567-239-1395
Mailing Address - Fax:
Practice Address - Street 1:17042 COUNTY ROAD 12
Practice Address - Street 2:
Practice Address - City:PIONEER
Practice Address - State:OH
Practice Address - Zip Code:43554-9633
Practice Address - Country:US
Practice Address - Phone:567-239-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 10356320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities