Provider Demographics
NPI:1558501783
Name:BRANN, DARA REBECCA (OTR/L)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:REBECCA
Last Name:BRANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DARA
Other - Middle Name:REBECCA
Other - Last Name:YANUSEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2451 SPRUCEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3974
Mailing Address - Country:US
Mailing Address - Phone:907-378-4833
Mailing Address - Fax:
Practice Address - Street 1:11901 BUSINESS BLVD
Practice Address - Street 2:STE. 209
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7701
Practice Address - Country:US
Practice Address - Phone:907-694-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK111984225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics