Provider Demographics
NPI:1881227536
Name:DATHER, BRIANNA M (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:M
Last Name:DATHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:BRIANNA
Other - Middle Name:M
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:420 GAFFNEY DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1823
Mailing Address - Country:US
Mailing Address - Phone:315-788-2730
Mailing Address - Fax:
Practice Address - Street 1:380 GAFFNEY DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1863
Practice Address - Country:US
Practice Address - Phone:315-788-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024492225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1881227536Medicaid