Provider Demographics
NPI:1932980273
Name:POOLE, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:POOLE
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 1:585 SEVILLE RD APT C1
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1032
Mailing Address - Country:US
Mailing Address - Phone:330-907-4682
Mailing Address - Fax:
Practice Address - Street 1:585 SEVILLE RD APT C1
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1032
Practice Address - Country:US
Practice Address - Phone:330-907-4682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No172A00000XOther Service ProvidersDriver
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child