Provider Demographics
NPI:1851417059
Name:BARRA, BREANNA LYNN (OTR)
Entity Type:Individual
Prefix:MS
First Name:BREANNA
Middle Name:LYNN
Last Name:BARRA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 DINATALE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-2819
Mailing Address - Country:US
Mailing Address - Phone:860-349-2142
Mailing Address - Fax:
Practice Address - Street 1:35 MARC DR
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-5708
Practice Address - Country:US
Practice Address - Phone:203-265-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003072225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist