Provider Demographics
NPI:1336678432
Name:BRODIN, DANA M (OTR/L)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:BRODIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ATLANTIC CIR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-2502
Mailing Address - Country:US
Mailing Address - Phone:401-741-3409
Mailing Address - Fax:
Practice Address - Street 1:626 PARK AVE STE 2A
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2154
Practice Address - Country:US
Practice Address - Phone:401-270-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI0277225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist