Provider Demographics
NPI:1043697121
Name:RIGGILO, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:RIGGILO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5348 COUNTY RD 25
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315
Mailing Address - Country:US
Mailing Address - Phone:740-361-2930
Mailing Address - Fax:
Practice Address - Street 1:5348 COUNTY RD 25
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315
Practice Address - Country:US
Practice Address - Phone:740-361-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.15003791041C0700X
347C00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No347C00000XTransportation ServicesPrivate Vehicle